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[Variceal hemorrhage in portal hypertension: role of surgery in the acute and elective situation].
Schweiz Med Wochenschr. 1999 Apr 24; 129(16):631-8.SM

Abstract

The role of surgery in portal hypertension has changed over time. The past decade has seen significant advances in pharmacotherapy (acute and elective), endoscopy and interventional radiology. However, mortality from the first bleeding remains constant between 30 and 50% and depends directly on patient risk (Child C). Surgical intervention during the acute bleeding phase carries a mortality rate of up to 70% and should therefore be avoided. About 90% of patients with acute variceal haemorrhage may satisfactorily be managed with pharmacotherapy and/or endoscopic banding alone. If bleeding persists, balloon tamponade (Linton) is indicated. In case of recurrent bleeding under maximal therapy (problem bleeder), delayed shunting may be indicated. In patients with Child A/B cirrhosis surgical mesocaval shunt with an interposition graft is preferred, whereas for transplant candidates a TIPS is used. The long-term outcome for surgical shunts is significantly better compared to TIPS. Secondary prophylaxis consists of medical treatment (propanolol) and repeated endoscopic banding. If rebleeding occurs under adequate therapy, surgery (mesocaval shunt/TIPS) should be evaluated. However, liver transplantation is the only curative therapeutic option for this life-threatening disease.

Authors+Show Affiliations

Klinik für Viszeral- und Transplantationschirurgie, Inselspital, Universität Bern. lukas.kraehenbuehl@insel.chNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article
Review

Language

ger

PubMed ID

10378247

Citation

Krähenbühl, L, et al. "[Variceal Hemorrhage in Portal Hypertension: Role of Surgery in the Acute and Elective Situation]." Schweizerische Medizinische Wochenschrift, vol. 129, no. 16, 1999, pp. 631-8.
Krähenbühl L, Seiler CA, Büchler MW. [Variceal hemorrhage in portal hypertension: role of surgery in the acute and elective situation]. Schweiz Med Wochenschr. 1999;129(16):631-8.
Krähenbühl, L., Seiler, C. A., & Büchler, M. W. (1999). [Variceal hemorrhage in portal hypertension: role of surgery in the acute and elective situation]. Schweizerische Medizinische Wochenschrift, 129(16), 631-8.
Krähenbühl L, Seiler CA, Büchler MW. [Variceal Hemorrhage in Portal Hypertension: Role of Surgery in the Acute and Elective Situation]. Schweiz Med Wochenschr. 1999 Apr 24;129(16):631-8. PubMed PMID: 10378247.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Variceal hemorrhage in portal hypertension: role of surgery in the acute and elective situation]. AU - Krähenbühl,L, AU - Seiler,C A, AU - Büchler,M W, PY - 1999/6/23/pubmed PY - 1999/6/23/medline PY - 1999/6/23/entrez SP - 631 EP - 8 JF - Schweizerische medizinische Wochenschrift JO - Schweiz Med Wochenschr VL - 129 IS - 16 N2 - The role of surgery in portal hypertension has changed over time. The past decade has seen significant advances in pharmacotherapy (acute and elective), endoscopy and interventional radiology. However, mortality from the first bleeding remains constant between 30 and 50% and depends directly on patient risk (Child C). Surgical intervention during the acute bleeding phase carries a mortality rate of up to 70% and should therefore be avoided. About 90% of patients with acute variceal haemorrhage may satisfactorily be managed with pharmacotherapy and/or endoscopic banding alone. If bleeding persists, balloon tamponade (Linton) is indicated. In case of recurrent bleeding under maximal therapy (problem bleeder), delayed shunting may be indicated. In patients with Child A/B cirrhosis surgical mesocaval shunt with an interposition graft is preferred, whereas for transplant candidates a TIPS is used. The long-term outcome for surgical shunts is significantly better compared to TIPS. Secondary prophylaxis consists of medical treatment (propanolol) and repeated endoscopic banding. If rebleeding occurs under adequate therapy, surgery (mesocaval shunt/TIPS) should be evaluated. However, liver transplantation is the only curative therapeutic option for this life-threatening disease. SN - 0036-7672 UR - https://www.unboundmedicine.com/medline/citation/10378247/[Variceal_hemorrhage_in_portal_hypertension:_role_of_surgery_in_the_acute_and_elective_situation]_ L2 - http://www.diseaseinfosearch.org/result/5881 DB - PRIME DP - Unbound Medicine ER -