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Options in the Treatment of Portal Hypertension Portal Hypertension, itself, is not an indication for treatment Only the complications of Portal Hypertension need treatment

The Complications of Portal Hypertension ,[object Object],[object Object]

UPPER DIGESTIVE BLEEDING ,[object Object],[object Object]

ASCITES ,[object Object],[object Object],[object Object]

SPLENOMEGALY ,[object Object],[object Object],[object Object],[object Object]

Surgical procedures used in portal hypertension treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Transgastric suture (esophageal transection) of esophageal varices ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The eso-gastric resection ,[object Object],[object Object],[object Object],[object Object],[object Object]

Operative Devascularisation ,[object Object],[object Object],[object Object]

Types of operative procedures(1) ,[object Object],[object Object],[object Object]

Types of operative procedures(2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sugiura M, Futagawa S. Esophageal transection with paraesophagogastric devascularization in the treatment of esophageal varices. World J Surg 1984;8:673.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Types of operative procedures(3)

Advantages of Devascularization Operations ,[object Object],[object Object],[object Object],[object Object],[object Object],Idezucki Y, Sanjo K, Bandai Y, Kawasaki S, Ohashi K Current strategy for oesophageal varices in Japan. American Journal of Surgery 1990 160:98–104

Portasystemic shunt ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Disadvantages of portasystemic shunts ,[object Object],[object Object],[object Object],[object Object]

Portacaval Shunt End-to-Side ,[object Object],[object Object],[object Object],[object Object],[object Object]

Portacaval Shunt Side-to-Side ,[object Object],[object Object],[object Object],[object Object],[object Object]

Portacaval Shunt Side-to-Side ,[object Object],[object Object],[object Object],[object Object]

Portacaval H-graft shunt ,[object Object],[object Object],[object Object]

Portacaval H-graft shunt ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sarfeh IJ, Rypins EB, Mason GR. A systematic appraisal of portacaval H-graft diameters: clinical and hemodynamic perspectives. Ann Surg 1986;204:356.

Splenorenal central shunt ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

SPLENORENAL CENTRAL SHUNT splenic vein left renal vein vein Proximal end to side anastomosis Spleen

Splenorenal distal shunt ( Warren) ,[object Object],[object Object],[object Object],Henderson JM, Warren WD, Millikan WJ, Galloway JR, Kawasaki S, Kutner MH. Distal splenorenal shunt with splenopancreatic disconnection: a 4-year assessment. Ann Surg 1989;210:332.

Splenorenal distal shunt ( Warren) ,[object Object],[object Object],[object Object]

Splenorenal distal shunt (Warren) ,[object Object],[object Object],[object Object],Henderson JM. Surgical treatment of portal hypertension – Baillieres Best Pract Res Clin Gastroenterol - 01-Dec-2000; 14(6): 911-25

Splenorenal distal shunt ,[object Object],[object Object],[object Object],[object Object],Boyer TD, Kokenes DD, Hetzler G, Kutner MH, Henderson JM. Effect of distal splenorenal shunt on survival of patients with primary biliary cirrhosis. Hepatology, 1994, 20(6):1482-1486.

Splenorenal distal shunt ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Mesocaval Shunt ,[object Object],[object Object],[object Object],[object Object],Gliedman M L, Margulies M The mesocaval shunt for portal decompression. In: Haimovici H (ed.) Surgical management of vascular diseases. 1984, Lippincott, Philadelphia, p 841

[object Object],[object Object],[object Object],[object Object]

Surgical prevention in portal hypertension ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Surgical treatment of upper digestive bleeding (1) ,[object Object],[object Object],[object Object],[object Object],Cello J P, Grendell J H, Crass R A, Weber T E, Trunkey D D Endoscopic sclerotherapy versus portacaval shunt in patients with severe cirrhosis and acute variceal hemorrhage. Long-term follow-up. New England Journal of Medicine 1987 316:11–15

Surgical treatment of upper digestive bleeding (2) ,[object Object],[object Object],Mitchell R L, Ignatius J A Distal splenorenal shunt: standard procedure for elective and emergency treatment of bleeding esophageal varices. American Journal of Surgery 1988 156:169–172 Terblanche J, Burroughs A K, Hobbs K E F Controversies in the management of bleeding esophageal varices. New England Journal of Medicine 1989 320:1393–1398, 1469–1475

Prevention of recurrent upper digestive bleeding ,[object Object],[object Object],[object Object],[object Object]

Surgical treatment according of portal hypertension (PH) type PRESINUSOIDAL SINUSOIDAL POSTSINUSOIDAL

PRESINUSOIDAL EXTRAHEPATIC INTRAHEPATIC

Presinusoidal PH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Extrahepatic

Presinusoidal PH ,[object Object],[object Object],[object Object],[object Object],[object Object],Intrahepatic

Sinusoidal PH (Cirrhosis) ,[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sinusoidal PH

Postsinusoidal PH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Caval vein not obstructed

Postsinusoidal PH with caval vein obstruction ,[object Object],Postsinusoidal PH with liver failure Liver transplant

Fundeni Clinical institute Department of General Surgery and Liver Transplant ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Mortality (1) ,[object Object],[object Object],[object Object],[object Object]

Mortality (1) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusions (1) ,[object Object],[object Object],[object Object],[object Object]

Conclusions (2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusions (3) ,[object Object],[object Object]

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