Survival and quality of life after portal blood flow preserving procedures in patients with portal hypertension and liver cirrhosis (original) (raw)
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Surgery, 1999
Since the advent of liver transplantation and transjugular intrahepatic portosystemic shunts (TIPS), the role of surgical portosystemic shunts in the treatment of portal hypertension has changed. However, we have continued to use portosystemic shunts in patients with noncirrhotic portal hypertension and in patients with Child's A cirrhosis. We performed 48 surgical portosystemic shunt procedures between 1988 and 1998. The outcomes of these patients were evaluated to assess the efficacy of this treatment. Data from 39 of 48 patients were available for analysis. The average follow-up was 42 months. Liver function generally remained stable for the patients; only 2 patients had progressive liver failure and required transplant procedures. Gastrointestinal bleeding (3 patients), encephalopathy (3 patients), and shunt thrombosis (3 patients) were rare. Patient survival was 81% at 4 years, similar to survival with liver transplantation (P = .22). Surgical shunts remain the treatment of choice for prevention of recurrent variceal bleeding in patients with good liver function and portal hypertension.
Selective shunts for portal hypertension: Current role of a 21-year experience
Liver Transplantation, 1997
The results of treatment of hemorrhagic portal hypertension with selective shunts over a 21-year period in a selected patient population are reported. Patients selected for surgical treatment had good cardiopulmonary and renal function, and most also had adequate liver function (141 Child-Pugh class A, 59 class B). Among 734 patients treated surgically for bleeding portal hypertension, 221 had selective shunts (168 distal splenorenal and 53 splenocaval shunts). Global operative mortality (in the 21-year period) was 14% and 12% for Child- Pugh A patients. Operative mortality in Child-Pugh A patients in the last 5 years was only 5%. The rate of rebleeding was 6%, rate of incapacitating encephalopathy was 5%, and rate of survival was 65% at 15 years (last 5 years: 88% at 1 year and 85% at 5 years). Good quality of life was demonstrated in 80% of surviving patients. Shunt patency was 94%. Postoperative portal blood flow changes occurred in 23% of cases (8% diameter reduction, 14% thrombosis). Compared with other forms of therapy (pharmacotherapy, sclerotherapy, and transjugular intrahepatic shunting), only liver transplantation offers similar results for these patients. In countries in which liver transplantation is not routinely performed, shunting with selective shunts is the treatment of choice for patients with good liver function.
Long term follow-up of 100 patients with portal hypertension treated by a modified splenorenal shunt
British Journal of Surgery, 1986
One hundred consecutive Child's A or B patients with portal hypertension who survived the index episode of variceal bleeding were electively treated by a distal splenorenal shunt modified by a retroperitoneal approach. The operative mortality of the whole series was 11 per cent, but fell from 16per cent in thefirst 50 patients to 6per cent in the second halfof the series.
Surgical management in portal hypertension
2016
Background: Portal hypertension commonly accompanies cirrhosis of liver and is a consequence of an increase in splanchnic blood flow secondary to vasodilatation and increased resistance to the passage of blood through the cirrhotic liver. Development of oesophageal varices (OV) is one of the major complications of portal hypertension. In present study we attempted to compare different surgical modalities in case of Portal Hypertension (PHT) by their indications, contraindications, complications and outcomes in a group of 50 patients. Aim and objectives: To study the indications, contraindications, complications and outcomes in different decompressive shunt procedure and devascularisation procedure, to discuss the advantages and disadvantages of different surgical procedures in case of portal hypertension, to discuss role of shunt surgery in modern era of liver transplantation. Materials and methods: During our work period from June 2008 to November 2010, all patient admitted in our ...
New trends in surgical treatment for portal hypertension
Hepatology Research, 2009
A number of surgical procedures have been developed to manage esophageal varices. Broadly, these can be classified as shunting and non-shunting procedures. While total shunt effectively reduces the incidence of variceal bleeding, it is associated with a high risk of hepatic encephalopathy. The distal splenorenal shunt (DSRS), a selective shunt, was developed by Warren in 1967 to preserve portal blood flow through the liver while lowering variceal pressure. The hope was that both bleeding and hyperammonemia would be prevented. The DSRS effectively prevents rebleeding, but still carries a risk of hyperammonemia. We improved the DSRS procedure by additionally performing splenopancreatic disconnection (SPD, i.e. skeletonization of the splenic vein from the pancreas to its bifurcation at the splenic hilum) and gastric transection (GT, i.e. transection and anastomosis of the upper stomach with an autosuture instrument). An alternative to shunting was developed by Sugiura and Futagawa in 1973. Esophageal transection (ET) divides and reanastomoses the distal esophagus and devascularizes the distal esophagus and proximal stomach; splenectomy, selective vagotomy, and pyloroplasty are performed concomitantly. DSRS was more effective than ET in preventing recurrence of esophageal varices, but was associated with a higher incidence of hyperammonemia. The incidence of hyperammonemia in patients who underwent DSRS with SPD plus GT was significantly lower than that in patients who underwent DSRS alone or those who underwent DSRS with SPD. In conclusion, there are various surgical treatments for esophagogastric varices. Distal splenorenal shunt with SPD plus GT is considered an adequate treatment for patients with esophagogastric varices.
University Journal of Medicine and Medical Specialities, 2016
In patients with refractory variceal bleed and well preserved liver function (Childs class A and B) surgical shunt and transjugular intrahepatic portosystemic shunt (TIPS) are the only few options available. The long-term survival depends on the severity of underlying liver disease, rather than on the variceal bleeding per se(1). Efficacy of TIPS in preventing variceal bleed is almost similar in comparison to splenorenal shunt (SRS) which may be a more cost effective option(2). Both have been used as salvage therapy for refractory variceal bleeding. We herein report a case of refractory variceal bleed after failed distal spleno-renal shunt managed with emergency TIPS in a patient with non cirrhotic portal hypertension.