Surgical treatment of non-cirrhotic presinusoidal portal hypertension
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Updated: Aug 21, 2026
Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
Miguel Angel Mercado1, Hector Orozco, Carlos Chan
1Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion, Salvador Zubiran, Mexico City, Mexico. mercadiazma@yahoo.com
Insights
Complete portoazygos disconnection is an effective surgical option for non-cirrhotic portal hypertension. This procedure offers low rebleeding rates and excellent long-term survival for patients with preserved liver function.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatology
Background:
- Non-cirrhotic portal hypertension (NCPH) presents a better prognosis due to preserved liver function.
- Surgical treatment is preferred for NCPH due to its lowest rebleeding rate.
- An extensive esophagogastric devascularization, termed complete portoazygos disconnection, was evaluated for NCPH patients.
Purpose of the Study:
- To evaluate the efficacy of complete portoazygos disconnection in managing non-cirrhotic portal hypertension.
- To assess the rates of rebleeding, encephalopathy, and survival following this surgical procedure.
Main Methods:
- A retrospective review of 31 patients with NCPH treated between 1991 and 2001.
- Patients underwent a two-stage (thoracic and abdominal) esophagogastric devascularization with modified esophageal transection.
- Outcomes measured included hemorrhage recurrence, encephalopathy, and patient survival.
Main Results:
- Thirty-one patients underwent the procedure; 54% exhibited a hypercoagulable state.
- No operative mortality (0-30 days) was observed across 62 total operations.
- Rebleeding occurred in 9% of cases, with no instances of encephalopathy. Five-year and 10-year survival rates were 97% and 93%, respectively.
Conclusions:
- Complete portoazygos disconnection is a highly effective surgical option for NCPH.
- The procedure is associated with low morbidity, mortality, and rebleeding rates.
- Good long-term survival outcomes support its use in selected NCPH patients.
Background/Aims:
Non-cirrhotic portal hypertension has a better prognosis than other forms of portal hypertension because of a well-preserved liver function in most cases. These patients are good candidates to receive surgical treatment, which is the therapeutic choice available with the lowest rebleeding rate. Because of abnormalities in the splanchnic vessels due to the nature of the diseases, many of them cannot be shunted. An extensive esophagogastric devascularization, the complete portoazygos disconnection, was evaluated.
Methodology:
A retrospective review of files of 31 patients, among 491 operations between 1991 an 2001 was carried out in a tertiary care Academic University Hospital. Patients comprised those with non-cirrhotic bleeding portal hypertension treated by means of complete portoazygos disconnection. Extensive two-stage (thoracic and abdominal) esophagogastric devascularization with modified transection of the esophagus was performed.
Main Outcome Measures:
recurrence of hemorrhage, encephalopathy and survival.
Results:
Thirty-one patients were treated. In 17 cases (54%) a hypercoagulable state was demonstrated. No operative mortality was observed (0-30 days) with a total of 62 operations (two stages per patient). No case of encephalopathy was observed and in 3 cases (9%) rebleeding was recorded. The survival curve showed a 5-year survival of 97% and a 10-year survival of 93%.
Conclusions:
Complete portoazygos disconnection is an excellent surgical alternative for patients with non-cirrhotic portal hypertension, with a low morbidity and mortality as well as a low rebleeding rate and good long-term survival.
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