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Bleeding due to portal hypertension: the role of surgery.
South Med J. 1988 Apr; 81(4):436-9, 451.SM

Abstract

Several therapeutic options are available to stop acute variceal bleeding or prevent its recurrence. Sclerotherapy has emerged as the optimal method for stopping acute bleeding, and as primary therapy for preventing recurrence. Surgery is required for the 30% to 40% in whom sclerotherapy fails. Selective variceal decompression has emerged as the best surgical option to balance bleeding control and maintenance of liver function. Survival is significantly improved at five years in nonalcoholic (75%) compared with alcoholic (45%) cirrhotic patients. Recent advances have modified the operative technique to better maintain portal perfusion. Total shunts stop bleeding, and may be used in emergencies. Devascularization procedures have a 20% to 40% rebleeding rate, but do not accelerate liver failure. Liver transplantation, which is increasingly indicated for patients with end-stage liver disease and variceal bleeding, is dictated by the degree of hepatic failure. To provide optimal patient care, a center should be able to offer all of the treatment methods.

Authors+Show Affiliations

Department of Surgery, Emory University School of Medicine, Atlanta, Ga 30322.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

3282316

Citation

Henderson, J M., and W D. Warren. "Bleeding Due to Portal Hypertension: the Role of Surgery." Southern Medical Journal, vol. 81, no. 4, 1988, pp. 436-9, 451.
Henderson JM, Warren WD. Bleeding due to portal hypertension: the role of surgery. South Med J. 1988;81(4):436-9, 451.
Henderson, J. M., & Warren, W. D. (1988). Bleeding due to portal hypertension: the role of surgery. Southern Medical Journal, 81(4), 436-9, 451.
Henderson JM, Warren WD. Bleeding Due to Portal Hypertension: the Role of Surgery. South Med J. 1988;81(4):436-9, 451. PubMed PMID: 3282316.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bleeding due to portal hypertension: the role of surgery. AU - Henderson,J M, AU - Warren,W D, PY - 1988/4/1/pubmed PY - 1988/4/1/medline PY - 1988/4/1/entrez SP - 436-9, 451 JF - Southern medical journal JO - South Med J VL - 81 IS - 4 N2 - Several therapeutic options are available to stop acute variceal bleeding or prevent its recurrence. Sclerotherapy has emerged as the optimal method for stopping acute bleeding, and as primary therapy for preventing recurrence. Surgery is required for the 30% to 40% in whom sclerotherapy fails. Selective variceal decompression has emerged as the best surgical option to balance bleeding control and maintenance of liver function. Survival is significantly improved at five years in nonalcoholic (75%) compared with alcoholic (45%) cirrhotic patients. Recent advances have modified the operative technique to better maintain portal perfusion. Total shunts stop bleeding, and may be used in emergencies. Devascularization procedures have a 20% to 40% rebleeding rate, but do not accelerate liver failure. Liver transplantation, which is increasingly indicated for patients with end-stage liver disease and variceal bleeding, is dictated by the degree of hepatic failure. To provide optimal patient care, a center should be able to offer all of the treatment methods. SN - 0038-4348 UR - https://www.unboundmedicine.com/medline/citation/3282316/Bleeding_due_to_portal_hypertension:_the_role_of_surgery_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=3282316.ui DB - PRIME DP - Unbound Medicine ER -