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Emergency and elective surgical treatment of portal hypertension. A review of 23 years' experience.
Ann R Coll Surg Engl. 1975 Sep; 57(3):148-58.AR

Abstract

A retrospective review of surgical treatment for portal hypertension during a 23-year period in a regional unit is reported and the immediate and subsequent management of patients with bleeding oesophageal varices is discussed. Fifty-four patients with recurrent varix haemorrhage uncontrolled by conservative methods have been treated by oesophageal transection with a mortality of 22.2% (26.6% for cirrhotic patients). Thirty-two per cent of the cirrhotics were alive after 2 years. Only a minority (12%) of the survivors were considered suitable for a subsequent shunt procedure. Therapeutic portacaval anastomosis has been performed on 65 patients with a 51.2% 5-year survival (43-5% for cirrhotic patients). Further haemorrhage due to shunt thrombosis occurred in 5-3% of cases. The frequent occurrence of portal-systemic encephalopathy, increasing with duration of time following a shunt, is emphasized. The high morbidity and mortality in the poor-risk cirrhotic indicated that this type of patient is unsuitable for a portal-systemic shunt and is better treated by medical means.

Links

PMC Free PDF

Authors

Kirby R
No affiliation info available
Burke FD
No affiliation info available
Jones JD
No affiliation info available

MeSH

AdultEmergenciesEsophageal and Gastric VaricesFemaleGastrointestinal HemorrhageHumansHypertension, PortalLiver CirrhosisPortacaval Shunt, Surgical

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

1081360

Citation

Kirby, R, et al. "Emergency and Elective Surgical Treatment of Portal Hypertension. a Review of 23 Years' Experience." Annals of the Royal College of Surgeons of England, vol. 57, no. 3, 1975, pp. 148-58.
Kirby R, Burke FD, Jones JD. Emergency and elective surgical treatment of portal hypertension. A review of 23 years' experience. Ann R Coll Surg Engl. 1975;57(3):148-58.
Kirby, R., Burke, F. D., & Jones, J. D. (1975). Emergency and elective surgical treatment of portal hypertension. A review of 23 years' experience. Annals of the Royal College of Surgeons of England, 57(3), 148-58.
Kirby R, Burke FD, Jones JD. Emergency and Elective Surgical Treatment of Portal Hypertension. a Review of 23 Years' Experience. Ann R Coll Surg Engl. 1975;57(3):148-58. PubMed PMID: 1081360.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergency and elective surgical treatment of portal hypertension. A review of 23 years' experience. AU - Kirby,R, AU - Burke,F D, AU - Jones,J D, PY - 1975/9/1/pubmed PY - 1975/9/1/medline PY - 1975/9/1/entrez SP - 148 EP - 58 JF - Annals of the Royal College of Surgeons of England JO - Ann R Coll Surg Engl VL - 57 IS - 3 N2 - A retrospective review of surgical treatment for portal hypertension during a 23-year period in a regional unit is reported and the immediate and subsequent management of patients with bleeding oesophageal varices is discussed. Fifty-four patients with recurrent varix haemorrhage uncontrolled by conservative methods have been treated by oesophageal transection with a mortality of 22.2% (26.6% for cirrhotic patients). Thirty-two per cent of the cirrhotics were alive after 2 years. Only a minority (12%) of the survivors were considered suitable for a subsequent shunt procedure. Therapeutic portacaval anastomosis has been performed on 65 patients with a 51.2% 5-year survival (43-5% for cirrhotic patients). Further haemorrhage due to shunt thrombosis occurred in 5-3% of cases. The frequent occurrence of portal-systemic encephalopathy, increasing with duration of time following a shunt, is emphasized. The high morbidity and mortality in the poor-risk cirrhotic indicated that this type of patient is unsuitable for a portal-systemic shunt and is better treated by medical means. SN - 0035-8843 UR - https://www.unboundmedicine.com/medline/citation/1081360/Emergency_and_elective_surgical_treatment_of_portal_hypertension__A_review_of_23_years'_experience_ DB - PRIME DP - Unbound Medicine ER -