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.

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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]

TIPS would decrease the pressure over the portal system and a decreased risk of complications, such as:^[2]

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 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]

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 is indicated in case of liver failure.
Liver failure may be happened due to any diseases, such as cirrhosis or chronic portal hypertension.^[6]

↑ 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.