Combined devascularization and proximal splenorenal shunt: is this a better option than either procedure alone?

Xu, Chong-En; Zhang, Shuguang; Yu, Zhen-hai; Li, Guangxin; Cao, Lili; Ruan, Chang-Le; Li, Zhaoting

doi:10.1007/s00534-003-0881-4

Cited by 10 publications

(16 citation statements)

References 12 publications

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“…Shunting and devascularization are the two main strategies based on different hemodynamic theories, and they have been suggested to be combined to reduce the PHT in liver cirrhotic patients [18]. Effects of devascularization alone and combined procedure on portal hemodynamics have been compared 11,17 ; however, data on the incidence of postoperative PVT are limited.…”

Section: Discussionmentioning

confidence: 99%

Effects of surgical procedures on the occurrence and development of postoperative portal vein thrombosis in patients with cirrhosis complicated by portal hypertension

Sun

Zhou

et al. 2015

International Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

Effects of surgical procedures on the occurrence and development of postoperative portal vein thrombosis in patients with cirrhosis complicated by portal hypertension

Sun

Zhou

et al. 2015

International Journal of Surgery

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“…PSS+PAD, ahead of schedule replaces spontaneous shunt, which slowly occurs after PAD with artificial shunt in operation. Combined devascularization and splenorenal shunt (PAD+PSS) significantly decreases portal venous flow and portal pressure, as well as maintaining hepatopetal flow, thus entailing fewer complications compared to either PAD or PSS, some scholars even advocated that PSS+PAD could be a primary selection in the operations for portal hypertension [53,54] . Compared to PSS or PAD, PSS+PAD prolongs operation time, aggravates surgical trauma, and damages liver function, which are the reasons why PSS+PAD cannot be generally performed.…”

Section: Combined Pss+padmentioning

confidence: 99%

Clinical analysis of surgical treatment of portal hypertension

Cai²,

Leng³

et al. 2005

WJG

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AIM:To review the experience in surgery for 508 patients with portal hypertension and to explore the selection of reasonable operation under different conditions. METHODS:The data of 508 patients with portal hypertension treated surgically in 1991-2001 in our centers were analyzed. Of the 508 patients, 256 were treated with portaazygous devascularization (PAD), 167 with portasystemic shunt (PSS), 62 with selective shunt (SS), 11 with combined portasystemic shunt and portaazygous devascularization (PSS+PAD), 9 with liver transplantation (LT), 3 with union operation for hepatic carcinoma and portal hypertension (HCC+PH). RESULTS:In the 167 patients treated with PSS, free portal pressure (FPP) was significantly higher in the patients with a longer diameter of the anastomotic stoma than in those with a shorter diameter before the operation (P<0.01). After the operation, FPP in the former patients markedly decreased compared to the latter ones (P<0.01). The incidence rate of hemorrhage in patients treated with PAD, PSS, SS, PSS+PAD, and HCC+PH was 21.09% (54/256), 13.77 (23/167), 11.29 (7/62), 36.36% (4/11), and 100% (3/3), respectively. The incidence rate of hepatic encephalopathy was 3.91% (10/256), 9.58% (16/167), 4.84% (3/62), 9.09% (1/11), and 100% (3/3), respectively while the operative mortality was 5.49% (15/256), 4.22% (7/167), 4.84% (3/62), 9.09% (1/11), and 66.67% (2/3) respectively. The operative mortality of liver transplantation was 22.22% (2/9). CONCLUSION:Five kinds of operation in surgical treatment of portal hypertension have their advantages and disadvantages. Therefore, the selection of operation should be based on the actual needs of the patients.

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“…Failure risk factors include Child C cirrhosis, high final portal pressure despite recanalization, splenic vein or SMV involvement and untreated hepatic malignancy [28,29]. Kim et al found a patency period of 30.1 ± 25.6 months in their 11 patients with postoperative benign portal vein stenosis [23].…”

Section: Discussionmentioning

confidence: 99%

“…The results of many studies on percutaneous transhepatic portal vein stent placement suggest that the procedure is safe and has few major complications [1,3,6,8,23,27].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Refractory Ascites after Pancreato-Duodenectomy - Time to Rethink an Old Dogma

Meillat¹,

Ewald²,

Piana³

et al. 2017

J Clin Case Rep

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A rare case of refractory ascites caused by benign portal vein stenosis after pancreatoduodenectomy (PD) is reported. A dogma claims that ascites is found in portal hypertension with an intrahepatic block only. However, in the postoperative state, the pathophysiologic condition is altered, which made diagnosis difficult.A 69-year-old man who had undergone PD for lower bile duct carcinoma in situ, developed in postoperative course a pseudoaneurysm of the common hepatic artery successfully treated by stent graft. Six months later, the patient developed refractory ascites. CT scan revealed a severe stricture in the main trunk of the portal vein, probably due to extrinsic compression by the stent in the hepatic artery. Percutaneous transhepatic portography was performed and stent-graft was placed over the stenotic segment. Portal blood flow was corrected immediately. One week after the stenting procedure the patient was free of ascites and control physical and biochemical examination three years later is completely normal.

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Combined devascularization and proximal splenorenal shunt: is this a better option than either procedure alone?

Cited by 10 publications

References 12 publications

Effects of surgical procedures on the occurrence and development of postoperative portal vein thrombosis in patients with cirrhosis complicated by portal hypertension

Effects of surgical procedures on the occurrence and development of postoperative portal vein thrombosis in patients with cirrhosis complicated by portal hypertension

Clinical analysis of surgical treatment of portal hypertension

Refractory Ascites after Pancreato-Duodenectomy - Time to Rethink an Old Dogma

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