Treatment Options for Portal Hypertension and its Complications

Options in the Treatment of Portal Hypertension Portal Hypertension, itself, is not an indication for treatment Only the complications of Portal Hypertension need treatment

The Complications of Portal Hypertension ,[object Object],[object Object]

UPPER DIGESTIVE BLEEDING ,[object Object],[object Object]

ASCITES ,[object Object],[object Object],[object Object]

SPLENOMEGALY ,[object Object],[object Object],[object Object],[object Object]

Surgical procedures used in portal hypertension treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Transgastric suture (esophageal transection) of esophageal varices ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The eso-gastric resection ,[object Object],[object Object],[object Object],[object Object],[object Object]

Operative Devascularisation ,[object Object],[object Object],[object Object]

Types of operative procedures(1) ,[object Object],[object Object],[object Object]

Types of operative procedures(2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sugiura M, Futagawa S. Esophageal transection with paraesophagogastric devascularization in the treatment of esophageal varices. World J Surg 1984;8:673.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Types of operative procedures(3)

Advantages of Devascularization Operations ,[object Object],[object Object],[object Object],[object Object],[object Object],Idezucki Y, Sanjo K, Bandai Y, Kawasaki S, Ohashi K Current strategy for oesophageal varices in Japan. American Journal of Surgery 1990 160:98–104

Portasystemic shunt ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Disadvantages of portasystemic shunts ,[object Object],[object Object],[object Object],[object Object]

Portacaval Shunt End-to-Side ,[object Object],[object Object],[object Object],[object Object],[object Object]

Portacaval Shunt Side-to-Side ,[object Object],[object Object],[object Object],[object Object],[object Object]

Portacaval Shunt Side-to-Side ,[object Object],[object Object],[object Object],[object Object]

Portacaval H-graft shunt ,[object Object],[object Object],[object Object]

Portacaval H-graft shunt ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sarfeh IJ, Rypins EB, Mason GR. A systematic appraisal of portacaval H-graft diameters: clinical and hemodynamic perspectives. Ann Surg 1986;204:356.

Splenorenal central shunt ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

SPLENORENAL CENTRAL SHUNT splenic vein left renal vein vein Proximal end to side anastomosis Spleen

Splenorenal distal shunt ( Warren) ,[object Object],[object Object],[object Object],Henderson JM, Warren WD, Millikan WJ, Galloway JR, Kawasaki S, Kutner MH. Distal splenorenal shunt with splenopancreatic disconnection: a 4-year assessment. Ann Surg 1989;210:332.

Splenorenal distal shunt ( Warren) ,[object Object],[object Object],[object Object]

Splenorenal distal shunt (Warren) ,[object Object],[object Object],[object Object],Henderson JM. Surgical treatment of portal hypertension – Baillieres Best Pract Res Clin Gastroenterol - 01-Dec-2000; 14(6): 911-25

Splenorenal distal shunt ,[object Object],[object Object],[object Object],[object Object],Boyer TD, Kokenes DD, Hetzler G, Kutner MH, Henderson JM. Effect of distal splenorenal shunt on survival of patients with primary biliary cirrhosis. Hepatology, 1994, 20(6):1482-1486.

Splenorenal distal shunt ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Mesocaval Shunt ,[object Object],[object Object],[object Object],[object Object],Gliedman M L, Margulies M The mesocaval shunt for portal decompression. In: Haimovici H (ed.) Surgical management of vascular diseases. 1984, Lippincott, Philadelphia, p 841

[object Object],[object Object],[object Object],[object Object]

Surgical prevention in portal hypertension ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Surgical treatment of upper digestive bleeding (1) ,[object Object],[object Object],[object Object],[object Object],Cello J P, Grendell J H, Crass R A, Weber T E, Trunkey D D Endoscopic sclerotherapy versus portacaval shunt in patients with severe cirrhosis and acute variceal hemorrhage. Long-term follow-up. New England Journal of Medicine 1987 316:11–15

Surgical treatment of upper digestive bleeding (2) ,[object Object],[object Object],Mitchell R L, Ignatius J A Distal splenorenal shunt: standard procedure for elective and emergency treatment of bleeding esophageal varices. American Journal of Surgery 1988 156:169–172 Terblanche J, Burroughs A K, Hobbs K E F Controversies in the management of bleeding esophageal varices. New England Journal of Medicine 1989 320:1393–1398, 1469–1475

Prevention of recurrent upper digestive bleeding ,[object Object],[object Object],[object Object],[object Object]

Surgical treatment according of portal hypertension (PH) type PRESINUSOIDAL SINUSOIDAL POSTSINUSOIDAL

PRESINUSOIDAL EXTRAHEPATIC INTRAHEPATIC

Presinusoidal PH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Extrahepatic

Presinusoidal PH ,[object Object],[object Object],[object Object],[object Object],[object Object],Intrahepatic

Sinusoidal PH (Cirrhosis) ,[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sinusoidal PH

Postsinusoidal PH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Caval vein not obstructed

Postsinusoidal PH with caval vein obstruction ,[object Object],Postsinusoidal PH with liver failure Liver transplant

Fundeni Clinical institute Department of General Surgery and Liver Transplant ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Mortality (1) ,[object Object],[object Object],[object Object],[object Object]

Mortality (1) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusions (1) ,[object Object],[object Object],[object Object],[object Object]

Conclusions (2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusions (3) ,[object Object],[object Object]

Treatment Options for Portal Hypertension and its Complications

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Treatment Options for Portal Hypertension and its Complications