[Selective portal-systemic shunts for bleeding portal hypertension]

Area of Science:

• Gastroenterology
• Surgical Innovation
• Hepatology

Background:

• Portal hypertension is a serious complication, often associated with liver cirrhosis.
• Selective shunts emerged as a surgical option for managing portal hypertension starting in the 1970s.

Purpose of the Study:

• To evaluate the long-term efficacy and safety of selective shunts for treating portal hypertension.
• To analyze operative mortality, survival rates, and complication incidence in patients undergoing selective shunt procedures.

Main Methods:

• A 15-year retrospective study involving 177 patients (155 with liver cirrhosis) treated with Warren, renosplenic, or splenocaval shunts.
• Analysis of elective procedures, operative mortality (global and Child A), survival rates, and postoperative complications including encephalopathy, rebleeding, shunt thrombosis, and portal vein alterations.

Main Results:

• Overall 15-year operative mortality was 14.4%, with 11.6% for Child A patients.
• Survival rates for Child A patients were 74.6% at 1 year, 68.2% at 5 years, and 64.6% at 15 years.
• Complications included encephalopathy (6.9%), rebleeding (6.2%), shunt thrombosis (6.2%), and portal vein reduction (13.3%) or thrombosis (20.5%).

Conclusions:

• Selective shunts are a viable and effective treatment for portal hypertension in patients with preserved liver function.
• The procedures offer significant long-term survival, with acceptable complication rates when performed electively.