The Choice of Surgical Management in Patients with Portal Hypertension

Abstract

Aim. To improve the results of surgical treatment of patients with syndrome of portal hypertension. Material and Methods. One hundred and sixty nine patients with syndrome of portal hypertension who underwent elective surgery were examined. 100 patients had liver cirrhosis and 69 patients – extrahepatic portal vein obstruction. Portocaval shunting was scheduled for all patients. Selective portocaval shunting was preferred in cirrhotic patients; maximal shunting using “side to side” or “H-type” mesentericocaval or splenorenal anastomoses was chosen for those who had extrahepatic portal vein obstruction. Results. Selective portocaval shunting was performed in 26 of 100 patients with liver cirrhosis. Seventy six patients underwent gastrotomy with direct oesophagogastric varices ligation. In case of extrahepatic portal vein obstruction portocaval shunting was applied in 69 patients and direct oesophagogastric varices ligation – in 26 patients. Shunt surgery was rejected due to high activity of the pathological process in liver, presence of hepatic encephalopathy, heart failure; and also according to ultrasonography and computed tomography of portal system. Satisfactory short-term results were obtained in 97% of patients. Overall mortality was 0,8%. Conclusion. Phased preoperative examination protocol should be applied for the optimization of surgical management in patients with portal hypertension: patients’ selection based on clinical and laboratory data, assessment of central hemodynamics and neurological status. It is necessary to determine hemodynamic and topographic features using ultrasonography and 3D computed tomography of portal and caval systems to forecast the ability to perform different types of portocaval shunting; to define type and extent of surgical intervention depending on intraoperative data