Clinical Analysis of Surgical Treatment of Portal Hypertension

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2005 Jul 30

PMID 16052687

Citations 3

Authors

Xin-bao Xu

Jing-xiu Cai

Xi-Sheng Leng

Jia-Hong Dong

Ji-Ye Zhu

Zhen-ping He

Fu-Shun Wang

Ji-Run Peng

Ben-li Han

Ru-yu Du

Affiliations

Soon will be listed here.

Abstract

Aim: To review the experience in surgery for 508 patients with portal hypertension and to explore the selection of reasonable operation under different conditions.

Methods: The data of 508 patients with portal hypertension treated surgically in 1991-2001 in our centers were analyzed. Of the 508 patients, 256 were treated with portaazygous devascularization (PAD), 167 with portasystemic shunt (PSS), 62 with selective shunt (SS), 11 with combined portasystemic shunt and portaazygous devascularization (PSS+PAD), 9 with liver transplantation (LT), 3 with union operation for hepatic carcinoma and portal hypertension (HCC+PH).

Results: In the 167 patients treated with PSS, free portal pressure (FPP) was significantly higher in the patients with a longer diameter of the anastomotic stoma than in those with a shorter diameter before the operation (P < 0.01). After the operation, FPP in the former patients markedly decreased compared to the latter ones (P < 0.01). The incidence rate of hemorrhage in patients treated with PAD, PSS, SS, PSS+PAD, and HCC+PH was 21.09% (54/256), 13.77 (23/167), 11.29 (7/62), 36.36% (4/11), and 100% (3/3), respectively. The incidence rate of hepatic encephalopathy was 3.91% (10/256), 9.58% (16/167), 4.84% (3/62), 9.09% (1/11), and 100% (3/3), respectively while the operative mortality was 5.49% (15/256), 4.22% (7/167), 4.84% (3/62), 9.09% (1/11), and 66.67% (2/3) respectively. The operative mortality of liver transplantation was 22.22% (2/9).

Conclusion: Five kinds of operation in surgical treatment of portal hypertension have their advantages and disadvantages. Therefore, the selection of operation should be based on the actual needs of the patients.

Citing Articles

Modified laparoscopic splenectomy and azygoportal disconnection combined with cell salvage is feasible and might reduce the need for blood transfusion.

Jiang G, Bai D, Chen P, Qian J, Jin S, Yao J World J Gastroenterol. 2015; 20(48):18420-6.

PMID: 25561811 PMC: 4277981. DOI: 10.3748/wjg.v20.i48.18420.

Management of upper gastrointestinal bleeding from portal hypertension: Elective or emergency operation?.

Liu S Pak J Med Sci. 2014; 30(3):574-7.

PMID: 24948982 PMC: 4048509. DOI: 10.12669/pjms.303.4520.

Laparoscopic splenectomy and azygoportal disconnection with intraoperative splenic blood salvage.

Wang Y, Ji Y, Zhu Y, Xie Z, Zhan X Surg Endosc. 2012; 26(8):2195-201.

PMID: 22278104 DOI: 10.1007/s00464-012-2159-x.

References

Xue H, Zhang H, Zhang Y, Jiang Q . [Portal anticoagulation in preventing thrombosis after porta-azygous devascularization for portal hypertension]. Zhonghua Wai Ke Za Zhi. 2002; 38(11):855-7. View

Pinto H, Abrantes A, ESTEVES A, Almeida H, Correia J . Long-term prognosis of patients with cirrhosis of the liver and upper gastrointestinal bleeding. Am J Gastroenterol. 1989; 84(10):1239-43. View

Huang Y, Zhong Y . [Evaluation of the remote results of various procedures in the treatment of portal hypertension]. Zhonghua Wai Ke Za Zhi. 1986; 24(12):722-4, 780. View

Inokuchi K, Kobayashi Y . [Selective shunt method for portal hypertension--our method of the left gastric venous-caval shunt]. Shujutsu. 1969; 23(2):138-50. View

Nordlinger B, Nordlinger D, Fulenwider J, Millikan W, Sones P, Kutner M . Angiography in portal hypertension: clinical significance in surgery. Am J Surg. 1980; 139(1):132-41. DOI: 10.1016/0002-9610(80)90242-1. View

Guan H, Chen Y, Qian H . [Expression of endothelin-1 and nitric oxide synthase mRNA in gastric mucosa of rats with cirrhosis and portal hypertensive gastropathy after disconnective operations]. Zhonghua Yi Xue Za Zhi. 2000; 78(9):702-3. View

Bhalerao R, Pinto A, Bapat R, Shetty S, Bhide P, Waingankar V . Selective transplenic decompression of oesophageal varices by distal splenorenal and splenocaval shunt. Gut. 1978; 19(9):831-7. PMC: 1412189. DOI: 10.1136/gut.19.9.831. View

DCruz K, Natarajan A . Emergency inferior mesenteric vein to left renal vein shunt in variceal bleeding: an alternative technique. Trop Gastroenterol. 2002; 22(4):230-1. View

Rosemurgy A, Zervos E, Bloomston M, Durkin A, Clark W, Goff S . Post-shunt resource consumption favors small-diameter prosthetic H-graft portacaval shunt over TIPS for patients with poor hepatic reserve. Ann Surg. 2003; 237(6):820-5; discussion 825-7. PMC: 1514681. DOI: 10.1097/01.SLA.0000072102.38993.05. View

10.

Triger D . Portal hypertensive gastropathy. Baillieres Clin Gastroenterol. 1992; 6(3):481-95. DOI: 10.1016/0950-3528(92)90034-c. View

11.

Yeo W, Sung J, Ward S, Chung S, Lee W, Li A . A prospective study of upper gastrointestinal hemorrhage in patients with hepatocellular carcinoma. Dig Dis Sci. 1995; 40(12):2516-21. DOI: 10.1007/BF02220435. View

12.

Thuluvath P, Yoo H . Portal Hypertensive gastropathy. Am J Gastroenterol. 2002; 97(12):2973-8. DOI: 10.1111/j.1572-0241.2002.07094.x. View

13.

Qiu F . [Evaluation of the pericardial devascularization in portal hypertension]. Zhonghua Wai Ke Za Zhi. 1983; 21(5):275-7. View

14.

Xu X, Cai J, Dong J, He Z, Han B, Leng X . [Effects of portaazygous disconnection, portocaval shunt and selective shunts on experimental rat liver cirrhosis]. Zhonghua Gan Zang Bing Za Zhi. 2005; 13(2):113-6. View

15.

Yang Z, Qiu F . [Pericardial devascularization with splenectomy for the treatment of portal hypertension]. Zhonghua Wai Ke Za Zhi. 2002; 38(9):645-8. View

16.

Gulberg V, Haag K, Rossle M, Gerbes A . Hepatic arterial buffer response in patients with advanced cirrhosis. Hepatology. 2002; 35(3):630-4. DOI: 10.1053/jhep.2002.31722. View

17.

Gao D, He Z, Wu J, Ma Q, Song H, Mei L . [Long-term results of combined splenorenal shunt and porta-azygos devascularization in patients with portal hypertension]. Zhonghua Wai Ke Za Zhi. 2002; 36(6):327-9. View

18.

Xu R, Ling Y, Qiu W . [The different influences of splenectomy plus ligation of pericardial vein and shunt on portal hypertensive gastropathy]. Zhonghua Wai Ke Za Zhi. 2000; 35(9):515-7. View

19.

Rahmani O, Wolpert L, Drezner A . Distal inferior mesenteric veins to renal vein shunt for treatment of bleeding anorectal varices: case report and review of literature. J Vasc Surg. 2002; 36(6):1264-6. DOI: 10.1067/mva.2002.129644. View

20.

Raia S, Da Silva L, Gayotto L, Forster S, Fukushima J, Strauss E . Portal hypertension in schistosomiasis: a long-term follow-up of a randomized trial comparing three types of surgery. Hepatology. 1994; 20(2):398-403. View