Update on Shunt Surgery

Glowka, Tim R.; Kalff, Jörg C.; Manekeller, Steffen

doi:10.1159/000507125

Cited by 9 publications

(5 citation statements)

References 47 publications

(83 reference statements)

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“…A proximal splenorenal shunt is a good option for diverting blood ow directly into the systemic system in non-cirrhotic patients. The patency rate is 87%, and the chances of re-bleeding are low (10%) [14]. In our study, proximal SRS was performed in 36 patients.…”

Section: Discussionmentioning

confidence: 69%

Surgical Management of Non-Cirrhotic Portal Hypertension: An Experience from a Specialized Hepatopancreatobiliary Centre

Ashraf,

Saeed,

Khan

et al. 2023

Preprint

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Introduction: Extrahepatic portal vein obstruction is one of the common causes of portal hypertension in non-cirrhotic patients. The sequelae of portal hypertension are hematemesis, portal gastropathy, hypersplenism, and growth retardation. Although advances in endoscopic and radiological interventions effectively manage the complications, only surgery still provides the single-step solution for portal hypertension and its associated complications. The objective of this study was to evaluate and share our experience of surgical management in patients presented with portal vein thrombosis. Methods: Patients from February 2019 to June 2023 who underwent surgery related to portal vein thrombosis were retrospectively reviewed. Data collected included clinical presentation, etiological features, associated complications, a surgical procedure performed, postoperative complications, and recurrence rate were evaluated. Results: 45 patients (median Age: 26 ± 11 years) underwent surgical procedures during this study period. A proximal splenorenal shunt was formed in 36 patients, and in 09 patients, splenectomy and devascularization surgery were performed. Complications developed during the postoperative course were abdominal collection, DVT, cholangitis, chyle leak, and hematemesis. All these complications were managed non-operatively. Only two patients had a single upper gastrointestinal bleeding episode managed conservatively with no further recurrence of symptoms. During a long-term follow-up of 5 years, only one patient presented with a recurrence of symptoms. Conclusion: Extrahepatic portal vein obstruction is one of the common causes of portal hypertension. Although endoscopic and radiological interventions have played a very influential role in managing these complications, surgery is still an effective one-time option with no significant morbidity or mortality.

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Section: Discussionmentioning

confidence: 69%

Surgical Management of Non-Cirrhotic Portal Hypertension: An Experience from a Specialized Hepatopancreatobiliary Centre

Ashraf,

Saeed,

Khan

et al. 2023

Preprint

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“…e merit belongs to the surgeons in Freiburg who promoted the method (Richter and Rössle) [7,8]. At present, more than 30 years after the first TIPS, the indications and contraindications of the approach are well-established [29][30][31][32][33][34][35][36][37]. TIPS is accepted today as a solution prior to hepatic transplant, a "bridge" toward transplant.…”

Section: Discussionmentioning

confidence: 99%

“…In short, a portohepatic venous fistula is created. Extensive studies have sought to establish the place of TIPS and of surgical shunts in the management of GIB due to variceal rupture [29][30][31][32][33][34][35][36]. Often, the previously mentioned statistics offer contradictory data.…”

Section: Discussionmentioning

confidence: 99%

The Portosystemic Shunt for the Control of Variceal Bleeding in Cirrhotic Patients: Past and Present

Radu

Prunoiu

Strâmbu

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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Based on an experience of more than 50 years in the treatment of portal hypertension (PHT), the authors review and analyze the evolution of the surgical portocaval shunt (PCS). We would like to provide an insight into the past of PCS, in order to compare it with the current state of the treatment of PHT complications. As a landmark of the past, we shall present statistics of more than 500 cases of PHT operated between 1968 and 1983. From this group, 238 patients underwent surgical portocaval shunting during a fifteen-year period. The behavior of the portal hemodynamics following PCS was studied and the postoperative decrease in portal pressure (PP), as well as the residual PP, were recorded. The portal manometric determinations were made by electronic recordings using the Hellige device and direct intraoperative recordings through the catheterization of a ramus in the portal area. The results of PCS are superposable, in terms of hemodynamic efficiency, with those of the intrahepatic shunt (TIPS—transjugular intrahepatic portosystemic shunt). The authors discuss the current place of PCS, in obvious decline in comparison with the situation 50 years ago. The current methods of controlling variceal bleeding represent obvious progress. PCS remains with very limited indications, in specific situations when the other therapeutic methods have failed or are not recommended.

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“…Mesenteric-caval and central splenorenal shunts, although effective, are considered secondary choices due to anastomoses on smaller, thrombosis-prone vessels. These procedures are preferred in the setting of portal hypertension due to portal vein thrombosis in non-cirrhotic patients [54][55][56] ; in this setting, especially in pediatric extrahepatic portal vein occlusion, a modified mesenteric-caval shunt, named Meso-Rex Shunt, can be applied [57] .…”

Section: Common Surgical Portosystemic Shunts Includementioning

confidence: 99%

Role of temporary portosystemic surgical shunt during liver resection to prevent a post-resection small for size-like syndrome

Lanari,

Polacco,

Cillo

2024

Hepatoma Res

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Liver resection stands as the gold-standard therapeutic approach for selected cases of hepatocellular carcinoma (HCC). The extent of resectable parenchyma hinges upon the underlying liver function and its regenerative potential. Consequently, cirrhosis may impede access to potentially curative interventions for HCC arising within this context. Cirrhotic patients undergoing liver resection face heightened susceptibility to post-hepatectomy liver failure (PHLF). The clinical profile of PHLF bears a resemblance to a well-documented syndrome within the liver transplant (LT) domain: Small-for-size syndrome (SFSS), a form of graft failure observed in the postoperative phase following LT with undersized or partial organs. Management of SFSS targets mitigating the overflow syndrome, achievable through diverse portal diversion techniques. Portal vein flow diversion encompasses procedures redirecting a variable proportion of portal vein flow towards systemic circulation. Consequently, derivative procedures aim to directly alleviate portal hypertension. Side-to-side portocaval shunts emerge as the most straightforward and efficacious means of decompressing the portal system. Furthermore, they afford flow calibration to diminish the incidence and severity of steal syndrome and hepatic encephalopathy, without compromising efficacy or hepatic function. Translating insights gleaned from LT complexities involving SFSS to liver resection, strategies involving portal flow diversion warrant consideration in efforts to forestall PHLF. This approach aims to extend the frontiers of liver surgery, broadening access to hepatectomy with curative intent, either as a standalone intervention or as part of a comprehensive treatment regimen where LT serves as a secondary option.

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Update on Shunt Surgery

Cited by 9 publications

References 47 publications

Surgical Management of Non-Cirrhotic Portal Hypertension: An Experience from a Specialized Hepatopancreatobiliary Centre

Surgical Management of Non-Cirrhotic Portal Hypertension: An Experience from a Specialized Hepatopancreatobiliary Centre

The Portosystemic Shunt for the Control of Variceal Bleeding in Cirrhotic Patients: Past and Present

Role of temporary portosystemic surgical shunt during liver resection to prevent a post-resection small for size-like syndrome

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