Portosystemic Shunt Surgery in Patients with Idiopathic Noncirrhotic Portal Hypertension

Karagül, Servet; Yağcı, Mehmet Ali; Tardu, Ali; Ertuğrul, İlker; Kırmızı, Serdar; Sümer, Fatih; Işık, Burak; Kayaalp, Cüneyt; Yilmaz, Sezai

doi:10.12659/aot.898253

Cited by 17 publications

(13 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A few patients with treatment failure may require liver transplantation. 32,[36][37][38] Fortunately, the prognosis of IPH is better than that of portal hypertension caused by liver cirrhosis if effectively managed. 17,18,33,39 As IPH is more prevalent in Asia, most of the currently available clinical data pertain to Japan and India, while few studies on IPH have been conducted in China.…”

Section: Introductionmentioning

confidence: 99%

Clinical features of idiopathic portal hypertension in China: A retrospective study of 338 patients and literature review

Sun

Shao

et al. 2018

J of Gastro and Hepatol

View full text Add to dashboard Cite

Background and Aim Idiopathic portal hypertension (IPH) refers to a relatively rare condition characterized by intrahepatic portal hypertension in the absence of underlying disease such as liver cirrhosis. Methods We retrospectively reviewed 338 patients with IPH that were diagnosed at the pathological consultation center of our hospital. Results The ratio of male to female patients was 1:1. Mean age at onset was 35.1 ± 16.5 years; male patients on average were 12 years younger than female patients at onset. The median duration from onset to IPH diagnosis was 12 months. In 50 patients, medication use may have been an etiological factor. The most common clinical manifestations were splenomegaly (91.3%) and hypersplenism (68.9%); 57.0% patients presented varicosis, while 25.1% patients had a history of variceal bleeding. Nodular regenerative hyperplasia was found in 22.2% liver biopsies. Among patients for whom laboratory data were available, 65.0%, 50.3%, and 71.4% patients presented leukopenia, anemia, and thrombocytopenia due to hypersplenism. Liver function was mostly in the compensated stage. Female patients showed worse leukopenia and anemia, while male patients were more likely to have abnormal serum transaminase and bilirubin levels. Sixty‐seven patients received surgical or interventional treatment. Conclusions High‐quality liver biopsy, detailed clinical information, and expert pathologist are necessary for diagnosis of IPH. IPH can occur concurrently with other liver disease such as hepatitis and drug‐induced liver injury. Medication appears to be an important etiological factor for IPH in China. Management approach was largely focused on treatment of portal hypertension and its complications.

show abstract

Section: Introductionmentioning

confidence: 99%

Clinical features of idiopathic portal hypertension in China: A retrospective study of 338 patients and literature review

Sun

Shao

et al. 2018

J of Gastro and Hepatol

View full text Add to dashboard Cite

show abstract

“…(12)(13)(14)(15)(16)(17) Experience regarding abdominal surgery in patients with INCPH is mostly limited to portosystemic shunt and/or splenectomy performed in adults or children from eastern countries. (5,(18)(19)(20) The present study thus aimed at evaluating the outcome of patients with INCPH undergoing abdominal surgery and at assessing the impact of preoperative portal decompression procedures.…”

mentioning

confidence: 99%

Abdominal Surgery in Patients With Idiopathic Noncirrhotic Portal Hypertension: A Multicenter Retrospective Study

et al. 2019

View full text Add to dashboard Cite

In patients with idiopathic noncirrhotic portal hypertension (INCPH), data on morbidity and mortality of abdominal surgery are scarce. We retrospectively analyzed the charts of patients with INCPH undergoing abdominal surgery within the Vascular Liver Disease Interest Group network. Forty‐four patients with biopsy‐proven INCPH were included. Twenty‐five (57%) patients had one or more extrahepatic conditions related to INCPH, and 16 (36%) had a history of ascites. Forty‐five procedures were performed, including 30 that were minor and 15 major. Nine (20%) patients had one or more Dindo‐Clavien grade ≥ 3 complication within 1 month after surgery. Sixteen (33%) patients had one or more portal hypertension–related complication within 3 months after surgery. Extrahepatic conditions related to INCPH (P = 0.03) and history of ascites (P = 0.02) were associated with portal hypertension–related complications within 3 months after surgery. Splenectomy was associated with development of portal vein thrombosis after surgery (P = 0.01). Four (9%) patients died within 6 months after surgery. Six‐month cumulative risk of death was higher in patients with serum creatinine ≥ 100 μmol/L at surgery (33% versus 0%, P < 0.001). An unfavorable outcome (i.e., either liver or surgical complication or death) occurred in 22 (50%) patients and was associated with the presence of extrahepatic conditions related to INCPH, history of ascites, and serum creatinine ≥ 100 μmol/L: 5% of the patients with none of these features had an unfavorable outcome versus 32% and 64% when one or two or more features were present, respectively. Portal decompression procedures prior to surgery (n = 10) were not associated with postoperative outcome. Conclusion: Patients with INCPH are at high risk of major surgical and portal hypertension–related complications when they harbor extrahepatic conditions related to INCPH, history of ascites, or increased serum creatinine.

show abstract

“…Five patients were male (56%). The mean Child-Pugh Score at the time of spleen embolization was 5.9 ± 1.3 [5][6][7][8] points, the mean MELD-Score 8.9 ± 2.6 [6][7][8][9][10][11][12][13][14]. All patients had splenomegaly with a mean spleen diameter of 16.6 ± 2.8 [13.3-22.3] cm.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…However, in some patients, TIPS implantation is (i) not possible due to contraindications (e.g., hepatic encephalopathy, advanced liver cirrhosis, congestive heart failure) or (ii) not feasible due to vascular disorders (e.g., splenic vein thrombosis) leading to sinistral PH without alteration of hepatic venous pressure gradient (HVPG) [4][5][6]. More invasive approaches to treatment of PH, such as shunt surgery (e.g., portocaval shunt, splenorenal shunt) or splenectomy, are effective as well [7][8][9][10][11]. However, surgical interventions are associated with relevant morbidity and mortality, as these patients frequently present with significant co-morbidities.…”

Section: Introductionmentioning

confidence: 99%

Partial spleen embolization reduces the risk of portal hypertension-induced upper gastrointestinal bleeding in patients not eligible for TIPS implantation

Buechter

Kahraman

Manka

et al. 2017

72. Jahrestagung Der Deutschen Gesellschaft Für Gastroenterologie, Verdauungs- Und Stoffwechselkrankheiten Mit Sektion Endoskop

View full text Add to dashboard Cite

Portosystemic Shunt Surgery in Patients with Idiopathic Noncirrhotic Portal Hypertension

Cited by 17 publications

References 0 publications

Clinical features of idiopathic portal hypertension in China: A retrospective study of 338 patients and literature review

Clinical features of idiopathic portal hypertension in China: A retrospective study of 338 patients and literature review

Abdominal Surgery in Patients With Idiopathic Noncirrhotic Portal Hypertension: A Multicenter Retrospective Study

Partial spleen embolization reduces the risk of portal hypertension-induced upper gastrointestinal bleeding in patients not eligible for TIPS implantation

Contact Info

Product

Resources

About