Portal hypertension: surgical management in the 1990s.

Published

Journal Article

BACKGROUND: Although liver transplantation offers definitive treatment for portal hypertension with end-stage liver failure, surgical portosystemic shunts avoid the risks of transplantation and immunosuppressive therapy, and transjugular intrahepatic portosystemic shunt (TIPS) creates a portosystemic shunt with minimal operative risk. The appropriate applications of these modalities are discussed. METHODS: All adults undergoing primary liver transplantation alone (PLT, n = 265), PLT after TIPS (n = 34), PLT after surgical shunts (n = 12), surgical shunt alone (n = 13), TIPS alone (n = 35), or surgical shunt after PLT (n = 5) served as the basis of this study. RESULTS: In contrast to surgical shunts before PLT, TIPS before PLT increased the 1-year graft survival. Surgical shunts alone were done in 18 patients with normal or near normal liver function with 100% survival. TIPS alone offered effective symptomatic relief to most patients, all of whom were judged not to be surgical candidates. CONCLUSIONS: TIPS, surgical shunts, and liver transplantation each have a logical role in management of portal hypertension. Surgical candidates with Child's B or C liver failure should be treated with liver transplantation, and TIPS offers effective treatment for nonsurgical candidates. Surgical shunts can be performed with excellent results in patients with Child's A liver disease. Portal vein occlusion with normal liver function can be successfully treated with surgical shunts.

Full Text

Duke Authors

Cited Authors

  • Knechtle, SJ; Kalayoglu, M; D'Alessandro, AM; Pirsch, JD; Armbrust, MJ; Sproat, IA; Wojtowycz, MM; McDermott, JC; Crummy, AB; Belzer, FO

Published Date

  • October 1994

Published In

Volume / Issue

  • 116 / 4

Start / End Page

  • 687 - 693

PubMed ID

  • 7940167

Pubmed Central ID

  • 7940167

International Standard Serial Number (ISSN)

  • 0039-6060

Language

  • eng

Conference Location

  • United States