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Surgery in elderly patients in Mexico. Portal hypertension surgery as an example
H Orozco1, M A Mercado, M Rodriguez-Davalos
1Surgical Division, Instituto Nacional de la Nutrición, Mexico City, Mexico.
Abstract:
Although people older than 65 years represent less than 5% of Mexico's registered population, medical care for elderly patients requires a multidisciplinary approach. In our academic university hospital, they are managed by a team of specialists. As an example of this approach, we evaluated the surgical treatment of bleeding portal hypertension in a highly selected elderly population. A retrospective study was done reviewing the files of 25 patients older than 65 years. All had good liver function (Child-Pugh class A and B) and had undergone elective surgery. Sixteen of them were women. The mean age was 68.8 years (age range, 65-76 years), and most had a diagnosis of cirrhosis. All patients were treated with portal blood flow-preserving procedures (selective shunts or Sugiura-Futagawa procedures). The operative mortality was 8%. Eight later deaths were recorded, with a mean follow-up of 25 months (range, 2-110 months). Survival (Kaplan-Meier) was 87% at 12 months, 54% at 60 months, and 45% at 110 months. Two rebleeding incidents were recorded as well as 3 cases of postoperative encephalopathy. We concluded that well-selected elderly patients, undergoing elective surgery with portal blood flow-preserving procedures, have a good postoperative outcome.
Insights
Surgical treatment for bleeding portal hypertension in elderly patients (older than 65) using portal blood flow-preserving procedures shows good outcomes. This approach is effective for carefully selected older adults with good liver function.
Area of Science:
- Hepatology
- Gastroenterology
- Surgical Oncology
Background:
- Elderly patients (>65 years) require specialized multidisciplinary care.
- Portal hypertension management in older adults is complex.
- Surgical intervention for bleeding portal hypertension in the elderly is less common.
Purpose of the Study:
- To evaluate the surgical treatment outcomes for bleeding portal hypertension in a selected elderly population.
- To assess the safety and efficacy of portal blood flow-preserving procedures in patients over 65.
- To analyze postoperative mortality and long-term survival in this demographic.
Main Methods:
- Retrospective study of 25 patients aged 65 and older with bleeding portal hypertension.
- Inclusion criteria: good liver function (Child-Pugh A/B) and elective surgery.
- Procedures: portal blood flow-preserving techniques (selective shunts, Sugiura-Futagawa).
Main Results:
- Operative mortality was 8%.
- Kaplan-Meier survival rates: 87% at 12 months, 54% at 60 months, 45% at 110 months.
- Complications included 2 rebleeding incidents and 3 cases of postoperative encephalopathy.
Conclusions:
- Elective surgery with portal blood flow-preserving procedures is associated with favorable outcomes in well-selected elderly patients.
- Careful patient selection and appropriate surgical techniques are crucial for managing bleeding portal hypertension in older adults.
- Multidisciplinary care enhances management of elderly patients with complex gastrointestinal conditions.