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[Surgical treatment of portal hypertension].
Zentralbl Chir. 2005 Jun; 130(3):238-45.ZC

Abstract

A switch to decompressive shunt procedures is mandatory if endoscopic therapy fails to control recurrent variceal hemorrhage. Surgical shunt procedures continue to be safe, highly effective and durable procedures to control variceal bleeding in patients with low operative risk and good liver function (Child A). In cirrhotics, elective operations using portal flow preserving techniques such as a selective distal splenorenal shunt (Warren) or a partial portocaval small diameter interposition shunt (Sarfeh) should be preferred. Rarely, end-to-side portocaval shunt may serve as a salvage procedure if emergent endoscopic treatment or TIPS insertion fail to stop bleeding. Until definitive results from randomized trials are available patients with good prognosis (Child-Pugh A and B) can be regarded as candidates for surgical shunts. For patients with noncirrhotic portal hypertension, in particular with extrahepatic portal vein thrombosis, portosystemic shunt surgery represents the only effective therapy which leads to freedom of recurrent bleeding and repeated endoscopies for many years, and improves hypersplenism without deteriorating liver function or encephalopathy. Gastroesophageal devascularization and other direct variceal ablative procedures should be restricted to treat endoscopic therapy failures without shuntable portal tributaries.

Authors+Show Affiliations

Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefässchirurgie, Rheinische Friedrich-Wilhelms-Universität, Bonn. martin.wolff@ukb.uni-bonn.deNo affiliation info available

Pub Type(s)

Comparative Study
English Abstract
Journal Article
Review

Language

ger

PubMed ID

15965877

Citation

Wolff, M, and A Hirner. "[Surgical Treatment of Portal Hypertension]." Zentralblatt Fur Chirurgie, vol. 130, no. 3, 2005, pp. 238-45.
Wolff M, Hirner A. [Surgical treatment of portal hypertension]. Zentralbl Chir. 2005;130(3):238-45.
Wolff, M., & Hirner, A. (2005). [Surgical treatment of portal hypertension]. Zentralblatt Fur Chirurgie, 130(3), 238-45.
Wolff M, Hirner A. [Surgical Treatment of Portal Hypertension]. Zentralbl Chir. 2005;130(3):238-45. PubMed PMID: 15965877.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Surgical treatment of portal hypertension]. AU - Wolff,M, AU - Hirner,A, PY - 2005/6/21/pubmed PY - 2005/11/11/medline PY - 2005/6/21/entrez SP - 238 EP - 45 JF - Zentralblatt fur Chirurgie JO - Zentralbl Chir VL - 130 IS - 3 N2 - A switch to decompressive shunt procedures is mandatory if endoscopic therapy fails to control recurrent variceal hemorrhage. Surgical shunt procedures continue to be safe, highly effective and durable procedures to control variceal bleeding in patients with low operative risk and good liver function (Child A). In cirrhotics, elective operations using portal flow preserving techniques such as a selective distal splenorenal shunt (Warren) or a partial portocaval small diameter interposition shunt (Sarfeh) should be preferred. Rarely, end-to-side portocaval shunt may serve as a salvage procedure if emergent endoscopic treatment or TIPS insertion fail to stop bleeding. Until definitive results from randomized trials are available patients with good prognosis (Child-Pugh A and B) can be regarded as candidates for surgical shunts. For patients with noncirrhotic portal hypertension, in particular with extrahepatic portal vein thrombosis, portosystemic shunt surgery represents the only effective therapy which leads to freedom of recurrent bleeding and repeated endoscopies for many years, and improves hypersplenism without deteriorating liver function or encephalopathy. Gastroesophageal devascularization and other direct variceal ablative procedures should be restricted to treat endoscopic therapy failures without shuntable portal tributaries. SN - 0044-409X UR - https://www.unboundmedicine.com/medline/citation/15965877/[Surgical_treatment_of_portal_hypertension]_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2005-836545 DB - PRIME DP - Unbound Medicine ER -