Portal hypertension surgery: Difference between revisions
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{{Portal hypertension}} | {{Portal hypertension}} | ||
{{CMG}}; {{AE}}{{EG}} | |||
==Overview== | |||
[[Surgery]] is not the first-line treatment option for patients with portal hypertension. [[Surgery]] is usually reserved for patients with either severe [[cirrhosis]], [[esophageal varices]], [[splenomegaly]], [[ascites]], or [[liver failure]]. | |||
==Surgery== | ==Surgery== | ||
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[[Transjugular intrahepatic portosystemic shunt]] | | {{#ev:youtube|O2u4_hF3234|500}} | ||
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[[Surgery]] is not the first-line treatment option for patients with portal hypertension. [[Surgery]] is usually reserved for patients with either:<ref name="pmid7618313">{{cite journal| author=Collins JC, Sarfeh IJ| title=Surgical management of portal hypertension. | journal=West J Med | year= 1995 | volume= 162 | issue= 6 | pages= 527-35 | pmid=7618313 | doi= | pmc=1022831 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7618313 }}</ref> | |||
* Severe [[cirrhosis]] | |||
* [[Esophageal varices]] | |||
* [[Splenomegaly]] | |||
* [[Ascites]] | |||
* [[Liver failure]] | |||
<br> | |||
===Transjugular intrahepatic portosystemic shunting=== | |||
* [[Transjugular intrahepatic portosystemic shunt|Transjugular intrahepatic portosystemic shunting (TIPS)]] is bypassing the high flow rate of [[portal vein]] into the [[Systemic vein|systemic veins]]. | |||
* [[TIPS]] would decrease the pressure over the [[portal system]] and a decreased risk of complications, such as:<ref name="pmid291109902">{{cite journal |vauthors=Lahat E, Lim C, Bhangui P, Fuentes L, Osseis M, Moussallem T, Salloum C, Azoulay D |title=Transjugular intrahepatic portosystemic shunt as a bridge to non-hepatic surgery in cirrhotic patients with severe portal hypertension: a systematic review |journal=HPB (Oxford) |volume= |issue= |pages= |year=2017 |pmid=29110990 |doi=10.1016/j.hpb.2017.09.006 |url=}}</ref> | |||
** [[Splenomegaly]] | |||
** [[Esophageal varices]] | |||
** [[Gastric varices]] | |||
** [[Collateral circulation|Collateral formations]] | |||
<br> | |||
=== Esophageal varices ligation === | |||
* [[Esophageal varices]] ligation is done through [[endoscopic]] approach. | |||
* The procedure start with a minimal suction of the [[Esophageal varices|varice]] in a tiny [[endoscopic]] tube. | |||
* Then when enough part of [[varices]] is been sucked into the tube, a ligation band is administered around the [[Esophageal varices|variceal]] root to block its [[circulation]].<ref name="pmid22816012">{{cite journal| author=Poza Cordon J, Froilan Torres C, Burgos García A, Gea Rodriguez F, Suárez de Parga JM| title=Endoscopic management of esophageal varices. | journal=World J Gastrointest Endosc | year= 2012 | volume= 4 | issue= 7 | pages= 312-22 | pmid=22816012 | doi=10.4253/wjge.v4.i7.312 | pmc=3399010 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22816012 }}</ref> | |||
<br> | |||
=== Splenectomy === | |||
* [[Splenectomy]] is total excision of [[spleen]] after correct ligation and cutting of [[splenic vein]] and [[Splenic artery|artery]]. | |||
* [[Splenectomy]] is the definitive treatment for [[Gastric varices|gastric variceal]] bleeding due to [[splenic vein thrombosis]].<ref name="pmid3500243">{{cite journal |vauthors=Bradley EL |title=The natural history of splenic vein thrombosis due to chronic pancreatitis: indications for surgery |journal=Int. J. Pancreatol. |volume=2 |issue=2 |pages=87–92 |year=1987 |pmid=3500243 |doi= |url=}}</ref> | |||
<br> | |||
=== Ascites treatment === | |||
* [[Refractory]] [[ascites]] that is not responsive to [[medical therapy]] is treated with [[Transjugular intrahepatic portosystemic shunt|TIPS]]. | |||
* [[Peritoneovenous shunt|Peritoneovenous shunts]] are the basic treatment for the refractory [[ascites]]. | |||
* [[Peritoneovenous shunt|Peritoneovenous shunts]] bypass the [[ascites]] fluid into the systemic [[veins]].<ref name="pmid1568775">{{cite journal |vauthors=Arroyo V, Ginès P, Planas R |title=Treatment of ascites in cirrhosis. Diuretics, peritoneovenous shunt, and large-volume paracentesis |journal=Gastroenterol. Clin. North Am. |volume=21 |issue=1 |pages=237–56 |year=1992 |pmid=1568775 |doi= |url=}}</ref> | |||
<br> | |||
=== Liver transplantation === | |||
*[[Liver transplantation]] is indicated in case of [[liver failure]]. | |||
*[[Liver failure]] may be happened due to any diseases, such as [[cirrhosis]] or chronic portal hypertension.<ref name="pmid3050180">{{cite journal| author=Starzl TE, Van Thiel D, Tzakis AG, Iwatsuki S, Todo S, Marsh JW et al.| title=Orthotopic liver transplantation for alcoholic cirrhosis. | journal=JAMA | year= 1988 | volume= 260 | issue= 17 | pages= 2542-4 | pmid=3050180 | doi= | pmc=3091380 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3050180 }}</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Hepatology]] | [[Category:Hepatology]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category: | [[Category:Emergency medicine]] | ||
[[Category: | [[Category:Up-To-Date]] | ||
{{WS}} | |||
{{WH}} |
Latest revision as of 14:18, 7 December 2017
Portal Hypertension Microchapters |
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Treatment |
Case Studies |
Portal hypertension surgery On the Web |
American Roentgen Ray Society Images of Portal hypertension surgery |
Risk calculators and risk factors for Portal hypertension surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]
Overview
Surgery is not the first-line treatment option for patients with portal hypertension. Surgery is usually reserved for patients with either severe cirrhosis, esophageal varices, splenomegaly, ascites, or liver failure.
Surgery
O2u4_hF3234|500}} |
9Vrmq8XKuXo|500}} |
Bv4Syt4Pyzc|500}} |
Surgery is not the first-line treatment option for patients with portal hypertension. Surgery is usually reserved for patients with either:[1]
Transjugular intrahepatic portosystemic shunting
- Transjugular intrahepatic portosystemic shunting (TIPS) is bypassing the high flow rate of portal vein into the systemic veins.
- TIPS would decrease the pressure over the portal system and a decreased risk of complications, such as:[2]
Esophageal varices ligation
- Esophageal varices ligation is done through endoscopic approach.
- The procedure start with a minimal suction of the varice in a tiny endoscopic tube.
- Then when enough part of varices is been sucked into the tube, a ligation band is administered around the variceal root to block its circulation.[3]
Splenectomy
- Splenectomy is total excision of spleen after correct ligation and cutting of splenic vein and artery.
- Splenectomy is the definitive treatment for gastric variceal bleeding due to splenic vein thrombosis.[4]
Ascites treatment
- Refractory ascites that is not responsive to medical therapy is treated with TIPS.
- Peritoneovenous shunts are the basic treatment for the refractory ascites.
- Peritoneovenous shunts bypass the ascites fluid into the systemic veins.[5]
Liver transplantation
- Liver transplantation is indicated in case of liver failure.
- Liver failure may be happened due to any diseases, such as cirrhosis or chronic portal hypertension.[6]
References
- ↑ Collins JC, Sarfeh IJ (1995). "Surgical management of portal hypertension". West J Med. 162 (6): 527–35. PMC 1022831. PMID 7618313.
- ↑ Lahat E, Lim C, Bhangui P, Fuentes L, Osseis M, Moussallem T, Salloum C, Azoulay D (2017). "Transjugular intrahepatic portosystemic shunt as a bridge to non-hepatic surgery in cirrhotic patients with severe portal hypertension: a systematic review". HPB (Oxford). doi:10.1016/j.hpb.2017.09.006. PMID 29110990.
- ↑ Poza Cordon J, Froilan Torres C, Burgos García A, Gea Rodriguez F, Suárez de Parga JM (2012). "Endoscopic management of esophageal varices". World J Gastrointest Endosc. 4 (7): 312–22. doi:10.4253/wjge.v4.i7.312. PMC 3399010. PMID 22816012.
- ↑ Bradley EL (1987). "The natural history of splenic vein thrombosis due to chronic pancreatitis: indications for surgery". Int. J. Pancreatol. 2 (2): 87–92. PMID 3500243.
- ↑ Arroyo V, Ginès P, Planas R (1992). "Treatment of ascites in cirrhosis. Diuretics, peritoneovenous shunt, and large-volume paracentesis". Gastroenterol. Clin. North Am. 21 (1): 237–56. PMID 1568775.
- ↑ Starzl TE, Van Thiel D, Tzakis AG, Iwatsuki S, Todo S, Marsh JW; et al. (1988). "Orthotopic liver transplantation for alcoholic cirrhosis". JAMA. 260 (17): 2542–4. PMC 3091380. PMID 3050180.