Right Porto-Ovarian H-Shunt for the Surgical Treatment of Symptomatic Portal Biliopathy: A Case Report and Literature Review

Vasiliadis, Konstantinos; Engelmann, Guido; Sauer, Peter; Weitz, Jürgen; Schmidt, Jan

doi:10.1155/2009/152195

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…In cases in which PB is due to biliary compression by PC, the detension of collateral vessels obtained with the reduction of portal pressure by PSS can resolve in the same time biliary obstruction[30]. The most common PSS performed are proximal spleno-renal shunt or mesocaval shunt, but other types of surgical shunts include meso-gonadal vein shunt, meso-renal shunt, right-porto ovarian shunt, shunt between a portal varix and cava[41,48-51]. …”

Section: Therapeutic Approachesmentioning

confidence: 99%

Therapeutic approaches for portal biliopathy: A systematic review

Franceschet¹,

Zanetto²,

Ferrarese³

et al. 2016

WJG

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Portal biliopathy (PB) is defined as the presence of biliary abnormalities in patients with non-cirrhotic/non-neoplastic extrahepatic portal vein obstruction (EHPVO) and portal cavernoma (PC). The pathogenesis of PB is due to ab extrinseco compression of bile ducts by PC and/or to ischemic damage secondary to an altered biliary vascularization in EHPVO and PC. Although asymptomatic biliary abnormalities can be frequently seen by magnetic resonance cholangiopancreatography in patients with PC (77%-100%), only a part of these (5%-38%) are symptomatic. Clinical presentation includes jaundice, cholangitis, cholecystitis, abdominal pain, and cholelithiasis. In this subset of patients is required a specific treatment. Different therapeutic approaches aimed to diminish portal hypertension and treat biliary strictures are available. In order to decompress PC, surgical porto-systemic shunt or transjugular intrahepatic porto-systemic shunt can be performed, and treatment on the biliary stenosis includes endoscopic (Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy, balloon dilation, stone extraction, stent placement) and surgical (bilioenteric anastomosis, cholecystectomy) approaches. Definitive treatment of PB often requires multiple and combined interventions both on vascular and biliary system. Liver transplantation can be considered in patients with secondary biliary cirrhosis, recurrent cholangitis or unsuccessful control of portal hypertension.

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Section: Therapeutic Approachesmentioning

confidence: 99%

Therapeutic approaches for portal biliopathy: A systematic review

Franceschet¹,

Zanetto²,

Ferrarese³

et al. 2016

WJG

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“…Portal biliopathy (PB) is recently introduced terminology referr ing to the morphologic alterations of the entire extra and intrahepatic biliary tree in patients with portal hypertension (PH) [154]. PH, especially when it is caused by chronic thrombotic obstruction of the extrahepatic portal vein, is commonly followed by the development of an abnormal periportal and pericholedochal bridging variceal network form ing the portal cavernoma, in an attempt to drain the extrahepatic portal system towards the systemic circulation [155][156][157]. Less common causes of PB include liver cirrhosis, portal vein fibrosis without cirrhosis and congenital hepatic fibrosis [155].…”

Section: Portal Biliopathymentioning

confidence: 99%

Benign Tumours and Pseudotumours Within the Porta Hepatis Masquerading as Perihilar Cholangiocarcinoma

Vasiliadis¹,

Ioannidis²,

Tsalis³

2019

Klin Onkol

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Background: Hilar cholangiocarcinoma (HC), also referred to as Altemeier-Klatskin's tumour, is a lethal primary extrahepatic carcinoma of biliary epithelial origin, aris ing within 2 cm of the hilar confluence. Radical surgical excision provides the best chance for a cure; however, the management of patients with HC is challeng ing not only because of the need for a high level of skill in biliary and hepatic resections, but also because of the difficulty in reach ing an accurate dia gnosis preoperatively. In fact, the differential dia gnosis of HC is a dia gnostic dilemma which is currently persisting, as modern, sophisticated dia gnostic modalities are not always able to provide a definitive preoperative dia gnosis. This difficulty is compounded by the fact that alternative entities that mimic HC may be present in up to 25% of patients with hilar obstruction. This makes precise preoperative characterisation of a hilar stricture extremely important by prevent ing unnecessary, high-risk, major surgical procedures. Therefore, alternative benign entities masquerad ing as Altemeier-Klatskin's tumour deserve an important place in the differential dia gnosis of hilar obstruction. Purpose: Consider ing the important clinical implications that a precise dia gnosis of the aetiological cause of a biliary obstruction at the liver hilum would have, this paper will focus on the differentiation between HC and benign hilar obstructions and will review benign tumours and pseudotumours masquerad ing as HC along with their specific dia gnostic features.

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Passive Versus Active Intra‐Abdominal Drainage Following Pancreatic Resection: Does A Superior Drainage System Exist? A Systematic Review and Meta‐Analysis

et al. 2021

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Postoperative pancreatic fistula (POPF) is a major source of morbidity following pancreatic resection. Surgically placed drains under suction or gravity are routinely used to help mitigate the complications associated with POPF. Controversy exists as to whether one of these drain management strategies is superior. The objective was to identify and compare the incidence of POPF, adverse events, and resource utilization associated with passive gravity (PG) versus active suction (AS) drainage following pancreatic resection. MEDLINE, EMBASE, CINAHL, and Cochrane Library databases were searched from inception to May 18, 2020. Outcomes of interest included POPF, post‐pancreatectomy hemorrhage (PPH), surgical site infection (SSI), other major morbidity, and resource utilization. Descriptive qualitative and pooled quantitative meta‐analyses were performed. One randomized control trial and five cohort studies involving 10 663 patients were included. Meta‐analysis found no difference in the odds of developing POPF between AS and PG (p = 0.78). There were no differences in other endpoints including PPH (p = 0.58), SSI (wound p = 0.21, organ space p = 0.05), major morbidity (p = 0.71), or resource utilization (p = 0.72). The risk of POPF or other adverse outcomes is not impacted by drain management following pancreatic resection. Based on current evidence, a suggestion cannot be made to support the use of one drain over another at this time. There is a trend toward increased intra‐abdominal wound infections with AS drains (p = 0.05) that merits further investigation.

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Right Porto-Ovarian H-Shunt for the Surgical Treatment of Symptomatic Portal Biliopathy: A Case Report and Literature Review

Cited by 3 publications

References 23 publications

Therapeutic approaches for portal biliopathy: A systematic review

Therapeutic approaches for portal biliopathy: A systematic review

Benign Tumours and Pseudotumours Within the Porta Hepatis Masquerading as Perihilar Cholangiocarcinoma

Passive Versus Active Intra‐Abdominal Drainage Following Pancreatic Resection: Does A Superior Drainage System Exist? A Systematic Review and Meta‐Analysis

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