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[Hepatic encephalopathy after portosystemic bypass surgery]
S R Margaryan1,2, Z B Mitupov1,2, A Yu Razumovsky1,2
1Pirogov Russian National Research Medical University, Moscow, Russia.
Insights
Portosystemic bypass surgery effectively treats gastrointestinal bleeding but risks hepatic encephalopathy in children. Selective shunts and mesoportal bypass may reduce this risk, optimizing outcomes.
Area of Science:
- Pediatric Surgery
- Hepatology
- Gastroenterology
Background:
- Portal hypertension often necessitates portosystemic bypass surgery for gastrointestinal bleeding.
- Hepatic encephalopathy remains a significant postoperative complication in pediatric surgery.
- Optimal management strategies for pediatric hepatic encephalopathy post-surgery are still under investigation.
Conclusions:
- Selective shunts and mesoportal bypass are recommended to improve outcomes in children with hepatic encephalopathy.
- Careful consideration of encephalopathy risk is vital when selecting surgical treatment.
- Further research into radical treatments for pediatric hepatic encephalopathy is warranted.
Abstract:
The most effective modern treatment for gastrointestinal bleeding following portal hypertension is portosystemic bypass surgery. Hepatic encephalopathy after these procedures is still an urgent problem in modern pediatric surgery, and radical treatment is unknown. To optimize treatment outcomes in children with hepatic encephalopathy, we should choose adequate treatment considering the risk of hepatic encephalopathy in the future. In this review, the authors discuss modern data on hepatic encephalopathy regarding symptoms, advantages and disadvantages of various treatment methods. Risk of hepatic encephalopathy with and without surgical treatment, as well as methods of diagnosis and treatment are particularly analyzed. Total portosystemic bypass surgery, especially portocaval shunt, is followed by higher risk of hepatic encephalopathy compared to selective shunts and physiological mesoportal bypass. The last two approaches are advisable to improve treatment outcomes in children with hepatic encephalopathy.
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