Extrahepatic portal obstruction: Clinical experience and surgical treatment in 105 patients

While the whole incidence of portal thrombosis is, in our experience, similar to other literature reports, there is evidence, in the last years, of an increase of idiopathic adult onset and post-cirrhotic versus childhood onset extrahepatic portal obstruction. One hundred five patients, or 24.6% of a 426 total series of patients operated upon for portal hypertension, suffered from an extra-hepatic block (52.4% pre-hepatic, and 47.6 mixed post-cirrhotic obstruction). The total series of patients were classified according to portal involvement degree: 47.6% had portal, 46.7% massive porto-radicular and 5.8% radicular obstruction. Physiopathologic differences were found among patients with acute, recanalized, or recurrent thrombosis. The clinical picture in massive or post-cirrhotic block was generally more severe, due to repeated massive and lifethreating digestive hemorrhages. The width of portal tree involvement proportionally affects the possibility of surgical management, with particular regard to shunting procedures, which, in our experience, seem to be much more effective than disconnecting operations, in avoiding bleeding recurrences and warranting a better long term survival.