Portal hypertension surgery
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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
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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:[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 varice 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 would be 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.