Operations for portal hypertension due to extrahepatic obstruction: results and 10 year follow up.

Pande, Girish; Reddy, V Mahidhar; Kar, PS; Sahni, Peush; Berry, Marcos; Tandon, B. N.; Nundy, Samiran

doi:10.1136/bmj.295.6606.1115

Cited by 46 publications

(42 citation statements)

References 13 publications

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“…Due to a large variation in the common etiologies of PHT and availability of emergency medical facilities for patients in Western countries vis-a-vis patients in tropical countries, the presentation, management and outcome differs significantly. 2 …”

Section: Definitionmentioning

confidence: 99%

“…Moreover, the control of portal hypertensive gastropathy, portal biliopathy and growth retardation in these patients can be addressed only by a portosystemic shunt. 2,8 The average survival of cirrhotic patients after shunt surgery, however, is only 5 years and a liver transplantation is the only definitive mode of treatment in these patients.…”

Section: Long Term Survivalmentioning

confidence: 99%

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Portal hypertension

Banerjee

2012

Medical Journal Armed Forces India

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Section: Definitionmentioning

confidence: 99%

Section: Long Term Survivalmentioning

confidence: 99%

Portal hypertension

Banerjee

2012

Medical Journal Armed Forces India

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“…The etiology of these presinusoidal causes of PHT has remained obscure, and these diseases are also not prevalent in the West (<10% of PHT cases) [1,3,4]. In our country, EHPVO affects the young (age of onset <20 years) with the first bleeding episode occurring before puberty in most patients [7][8][9]. Patients with EHPVO have good liver function, which remains preserved over the long term; amoderately enlarged spleen; tolerate variceal bleeding episodes well; rarely develop ascites (except during an acute bleed or in children <5 years); and do not show signs of liver decompensation such as encephalopathy.…”

Section: Natural History Of Phtmentioning

confidence: 99%

“…Patients with EHPVO have good liver function, which remains preserved over the long term; amoderately enlarged spleen; tolerate variceal bleeding episodes well; rarely develop ascites (except during an acute bleed or in children <5 years); and do not show signs of liver decompensation such as encephalopathy. Children and young adults with EHPVO may have significant growth retardation (50%), symptomatic hypersplenism (15-20%), and may develop symptomatic portal biliopathy in the long run as a consequence of the periportal cavernoma compressing on the extrahepatic bile duct [8][9][10]. The block in portal vein mainly affects the junction of superior mesenteric vein and splenic vein in 85-90% of cases with EHPVO, whereas the entire splenoportal axis is obliterated in 10-15% [8,9].…”

Section: Natural History Of Phtmentioning

confidence: 99%

“…Children and young adults with EHPVO may have significant growth retardation (50%), symptomatic hypersplenism (15-20%), and may develop symptomatic portal biliopathy in the long run as a consequence of the periportal cavernoma compressing on the extrahepatic bile duct [8][9][10]. The block in portal vein mainly affects the junction of superior mesenteric vein and splenic vein in 85-90% of cases with EHPVO, whereas the entire splenoportal axis is obliterated in 10-15% [8,9]. The hypothesis that patients with EHPVO outgrow their PHT in their teens by developing spontaneous splenorenal collaterals has not been substantiated.…”

Section: Natural History Of Phtmentioning

confidence: 99%

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Current Role of Surgery in Portal Hypertension

Pal

2011

Indian J Surg

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Treatment for portal hypertension (PHT) has evolved from surgery being the only option during the 1970s to the wide range of options currently available. Surgery has not vanished from the therapeutic armamentarium, but its role has changed and is constantly evolving. The present review primarily focuses on the role of surgery in tackling patients with PHT and varices with regard to the Indian scenario and also looks at its relevance, given the availability of a host of other therapeutic options.Keywords Portal hypertension . Portosystemic shunt . Surgery . Variceal haemorrhage Pathophysiology of PHTFor understanding how surgery can help modify the natural course in patients with PHT, it is necessary to understand its pathophysiology and the natural history of varices in such patients. PHT is usually the consequence of increased resistance to portal blood flow coupled with increased blood flow through the splanchnic circulation because of a hyperdynamic circulatory state that exists both in cirrhotics and to some extent in noncirrhotic etiologies (large congested splenomegaly) as well. Traditionally, at the ultrastructural level, PHT has been classified into presinusoidal, sinusoidal, and postsinusoidal. It is for the sinusoidal and postsinusoidal blocks that there is an accurate but invasive way of monitoring the portal pressure by using the method to estimate the hepatic venous pressure gradient (HVPG) in the vascular/hemodynamic lab [1][2][3]. In cirrhotic patients, as about a third to half of them will actually have PHT; HVPG >5 mmHg indicates PHT. PHT becomes clinically significant when the HVPG is ≥10 mmHg [1][2][3]. This is the pressure threshold when PHT leads to the formation of esophagogastric varices, retroperitoneal and periportal collaterals, hypersplenism, low serum albuminascitic albumin gradient ascites, spontaneous bacterial peritonitis, etc. Varices rupture and bleed only when the HVPG >12 mmHg [1][2][3]. Natural History of PHTIt has been estimated that varices are present in about 30-40% of compensated cirrhotics and nearly two-thirds of the decompensated patients. In cirrhotic patients without varices on the first endoscopy, the annual incidence of new varices is between 5% and 10% [1,4]. Once developed, the progression of varices from small to large depends on the deterioration of liver function and continued hepatic insult (virus-, alcohol-, metabolic-, drug-induced, etc.). The overall annual incidence of bleeding is about 4% and this increases to 15% per year in those with large varices, red signs, and poor Child's status [1,[4][5][6]. About a third of the cirrhotic patients with varices will bleed and the mortality following each episode of bleeding is about 20% (maybe higher) in experienced tertiary health centers. Early mortality (within 6 weeks) following an acute episode of variceal bleeding depends on the etiology of PHT, the severity of underlying liver disease (Child's C, model for end-stage liver disease [MELD] >18), actively bleeding varices, bleeding gastric varices (GV...

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Assessment of injection sclerotherapy in the management of 152 children with oesophageal varices

Howard

Stringer

Mowat

1988

Journal of British Surgery

171

107

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A total of 152 consecutive children with oesophageal varices have been endoscopically reviewed since 1979. In all, 108 of these children presented with variceal bleeding which was managed by injection sclerotherapy. Variceal obliteration was achieved in 33 (92 per cent) children with extrahepatic portal hypertension and 54 (75 per cent) with intrahepatic portal hypertension. Prophylactic injection sclerotherapy was used to obliterate large varices in 11 children with no history of haemorrhage. Bleeding episodes occurred in 38 (39 per cent) children before variceal obliteration was complete. However, the mortality rate from variceal bleeding was only 1 per cent. Complications were oesophageal ulceration (29 per cent) and stricture (16 per cent) which both resolved with conservative management. During a mean follow-up period of 2.9 years after sclerotherapy, recurrent oesophageal or gastric varices developed in 12 (12 per cent) cases, with rebleeding in 9 (9 per cent), but all responded successfully to a second course of treatment. These results are superior to contemporary surgical management and injection sclerotherapy should therefore currently be the primary treatment of choice for bleeding oesophageal varices in children.

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Operations for portal hypertension due to extrahepatic obstruction: results and 10 year follow up.

Cited by 46 publications

References 13 publications

Portal hypertension

Portal hypertension

Current Role of Surgery in Portal Hypertension

Assessment of injection sclerotherapy in the management of 152 children with oesophageal varices

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