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Updated: Jun 3, 2026

Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
[Management of patients with cirrhosis and portal hypertension-related bleeding]
Maxime Gasperment1, Marika Rudler1,2
1Service d'hépato-gastroentérologie, hôpital La Pitié-Salpêtrière, AP-HP, Paris, France.
Abstract:
Acute variceal bleeding treatment in patients with portal hypertension combines vasoactive drugs, prophylactic antibiotics, hepatic encephalopathy prophylaxis and upper gastrointestinal endoscopy for variceal treatment (elastic band ligation and/or tissue adhesive injection), on top of non-specific measures. Failure to control bleeding must lead to salvage TIPS (Transjugular Intrahepatic Portosystemic Shunt) discussion, after esophageal tamponade (balloon or stent).Pre-emptive TIPS within 72h must systematically be considered in high-risk patients to reduce rebleeding and mortality. Pre-emptive TIPS must also be discussed in case of gastric variceal bleeding.Following the acute bleeding episode, secondary prophylaxis combines non-selective betablockers and recurrent endoscopic treatments (except after TIPS). Liver transplantation must be discussed in certain cases of refractory bleeding or early relapse after TIPS implantation.
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