(Surgical) Treatment of portal hypertension

Abstract

Portal hypertension is a major complication of liver cirrhosis and may lead to life-threatening hemorrhage of esophageal varices, ascites, hepatic encephalopathy and/or renal failure. From the pathophysiological point of view, this hypertension is caused by an increased intrahepatic resistance due to the liver cirrhosis and is aggravated by a decreased sensitivity to endogenous vasopressors and an increased local concentration of vasodilators. The therapeutic options range from symptomatic medical treatment to endoscopic treatment (band ligation) to radiological interventions (placement of a transjugular intrahepatic portosystemic shunt) to surgical procedures. In this review, we present different treatment regimes for the treatment of portal hypertension focusing on the different shunt procedures for surgical treatment of portal hypertension. The operative options include side-to-side shunts as well end-to-side anastomoses between the portal vein and the inferior vena cava, distal spleno-renal shunts (Warren-shunts) and mesocaval shunt procedures (Drapanas-shunts). Furthermore, there are several rarely performed shunts (e.g. Linton-shunts) and devascularization procedures. While liver transplantation is an option for curative treatment of liver cirrhosis, the different shunt procedures are important for the symptomatic treatment of portal hypertension, especially in CHILD-PUGH A patients. Furthermore, due to the persistent shortage of donor organs the shunt procedures are important interventions prior to transplantation to prevent potential life-threatening complications of portal hypertension, such as massive hemorrhage of esophageal varices, as a bridging therapy to liver transplantation. ©2011 Nova Science Publishers, Inc. All rights reserved.