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Surgical Options for the Management of Portal Hypertension

  • Portal Hypertension (K Brown, Section Editor)
  • Published:
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Abstract

In the current age of endoscopic and interventional radiologic management of bleeding varices, the paradigm of surgical management for portal hypertension has radically shifted. There remains, however, a less common but important role for the well-trained surgeon who understands and is capable of managing portal hypertension. Patients who may benefit from surgical intervention are those with early cirrhosis or non-cirrhotic portal hypertension and suffer from variceal bleeding due to the consequences of portal, mesenteric, or splenic vein thrombosis. In addition, good surgical candidates who have limited access to care, may not be capable of close follow-up, or who have had failed prior therapy can benefit from more definitive surgical shunting. Liver transplantation has also changed the landscape in managing portal hypertension as the ultimate treatment for patients with advanced cirrhosis. Limited indications and fewer surgeons having been exposed to shunting procedures for portal hypertension have resulted in fewer shunts being performed, though they remain indicated under special circumstances. It is critical that we discern the role of various treatment options in different clinical scenarios and appreciate that under certain circumstances, a surgical intervention is indicated. This article reviews the history and progression of surgery for portal hypertension and highlights the current role of the surgeon in the era of multidisciplinary intervention. Furthermore, an algorithm for current management of variceal bleeding is presented.

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Conflict of Interest

Marwan Abouljoud, MD, Lauren Malinzak, MD, and David Bruno MD declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Henry Ford Transplant Institute, Division of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA

    Marwan Abouljoud, Lauren Malinzak & David Bruno

  2. Henry Ford Transplant Institute, Henry Ford Hospital, 2799 W. Grand Blvd, CFP2, Detroit, MI, 48202, USA

    Marwan Abouljoud

Authors
  1. Marwan Abouljoud
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  2. Lauren Malinzak
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  3. David Bruno
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Corresponding author

Correspondence to Marwan Abouljoud.

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This article is part of the Topical Collection on Portal Hypertension

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Abouljoud, M., Malinzak, L. & Bruno, D. Surgical Options for the Management of Portal Hypertension. Curr Hepatology Rep 14, 225–233 (2015). https://doi.org/10.1007/s11901-015-0276-4

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  • DOI: https://doi.org/10.1007/s11901-015-0276-4

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