Surgical treatment of portal hypertension: 45 year experience

To review the experience in surgery for 912 patients with portal hypertension.

The 912 patients were divided into three groups: before 1978 (group A), 1978 - 1989 (group B), and 1990 - 1998 (group C). The results were reviewed of portosystemic shunt (PSS), disconnection and disconnection plus PSS for emergency and elective operation at different periods.

In the 912 patients of groups A, B, C, the number of PSS, disconnection, and PSS plus disconnection was 345, 13, 0; 84, 209, 0; 63, 204, 63, respectively. The number of emergency operation was 45, 13 and 4 in each group. The operative mortality of shunt in the groups A, B, C was 7.82%, 7.14% and 0, respectively; that of disconnection in the groups A, B, C 15.38%, 6.28% and 4.94%; and that of PSS plus disconnection in group C 3.51%. Encephalopathy occurred in 14.37% of the PSS group, in 5.68% of the disconnection group, and in 5.77% of the disconnection plus PSS group. Rebleeding occurred in 10.78% of the PSS group, in 18.95% of the disconnection group, and in 7.69% of the disconnection plus PSS group.

Operative indications for the cirrhotic patients with portal hypertension depend on their liver function. For those patients with poor liver function, surgery is considered when their liver function is improved. We suggest prophylactic operation is valuable. Other indices from barium meal, color ultrasound, and endoscopy are also considered. The number of emergency operation has been decreasing. Since the 1980s, disconnection operation has been adopted increasingly. In our hospital, the number of patients receiving disconnection has been increasing from the early 1980s and the operation has almost replaced shunt operation in the 1990s. Disconnection combined with splenorenal shunt can lower the portal pressure and maintain the portal flow. Disconnection combined with splenorenal shunt seems to be a better procedure of choice.