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New pathways in portal hypertension surgery

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Abstract

An individualized treatment of portal hypertension is advocated. The treatment is suggested to be based upon the presence of complications to the disease: bleeding oesophageal varices, insufficient cardia function, regurgitation and oesophagitis, hyperacidity, stomach and duodenal ulcer, ascites and hypersplenism.

The choice of method of treatment of the patient depends on the presence of the symptoms. There are several methods available. These can be divided in methods directed against one symptom—unisymptomatic treatment- and methods directed against several symptoms—polysymptomatic treatments. The author advocates a more frequent use of decongestion operations and pexi operations. For acute control of bleeding varices it seems that sclerotherapy is the preferred choice at present.

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References

  1. Akita, H., Katsuki, T., Sakoda, K., Inoshima, Y. and Takesue, M.: Treatment of Budd-Chiari syndrome with splenopneumopexy,Acta Med. Univ. Kagoshima, 10: 49, 1968.

    Google Scholar 

  2. Akita, H. and Sakoda, K.: Splenopneumopexy as a surgical treatment for portal hypertension in children,Acta Med. Univ. Kagoshima 15: 1, 1973.

    Google Scholar 

  3. Auvert, J., le Brigand, H., Seringe, P., Michel, J.R. et Farge, C.: Possibilités thérapeutiques de la splenopexie intra-pulmonaire dans certains cas d'hypertension portale,Ann. Chir. Thorac. Cardiovasc. 5: 83, 1966.

    PubMed  CAS  Google Scholar 

  4. Auvert, J., le Brigand, H., Merlier, M., et Farge, C.: Plexie spléno-pulmonaire par implantation intra-pulmonaire du pole supér eur de la rate dans le traitement de l'hypertension portale par trombo-phlébite spléno-portale. Intrathorakale Milzverlagerung bei portaler Hypertension. Schattauer Verlag, Stuttgart-New York, 1969.

    Google Scholar 

  5. Banti, G.: Dell anemia splenica,Arch. d. scuola d'anat. patol. Florence 2: 53, 1883.

    Google Scholar 

  6. Bengmark, S.: Surgical management of portal hypertension,Clinics in Gastroenterology 4: 395, 1975.

    PubMed  CAS  Google Scholar 

  7. Bengmark, S., Börjesson, B., Lunderquist, A. and Sigstedt, B.: Subcutaneous transposition of the spleen-a method for treatment of complications in portal hypertension? To be published.Ann. Surg. 1977.

  8. Berg, A.A. and Rosenthal, N.: Ligation of the splenic artery for thrombocytopenic purpura and congestive splenomegaly,J. Mt. Sinai Hosp. 8: 382, 1942.

    Google Scholar 

  9. Bismuth, H., Franco, D. and Hepp, J.: Portal-systemic shunt in hepatic cirrhosis: Does the type of shunt desisively influence the clinical result.Ann. Surg. 179: 209, 1974.

    PubMed  CAS  Google Scholar 

  10. Blain, A.W.: Ligation of the splenic artery for Banti's disease. Report of case. Experimental studies,Surg. Gynecol. Obstet. 26: 660, 1918.

    Google Scholar 

  11. Blain, A.W. and Blain, A., III: Ligation of the splenic artery, operation of choice in selected cases of portal hypertension and Banti's syndrome.Ann. Surg. 131: 92, 1950.

    PubMed  CAS  Google Scholar 

  12. Blakemore, A.H.: Portacaval shunting for portal hypertension,Surg. Gynecol. Obstet. 94: 443, 1952.

    PubMed  CAS  Google Scholar 

  13. Blalock, A.: The use of shunt or by-pass operations in the treatment of certain circulatory disorders, including portal hypertension and pulmonic stenosis,Ann. Surg., 125: 129, 1947.

    PubMed  CAS  Google Scholar 

  14. Blendis, L. M., Bank, D.C., Ramboer, C. and Williams, R.: Spleen and splanchnic haemodynamics in blood dyscrasia and other splenomegalies,Clin. Sci. 38: 73, 1970.

    PubMed  CAS  Google Scholar 

  15. Boerema, I., Klopper, P.J. and Holscher, A.A.: Transabdominal ligation-resection of the esophagus in cases of bleeding esophageal varices.Surgery 67: 409, 1970.

    PubMed  CAS  Google Scholar 

  16. Bourgeon, R.: La transposition thoracique de la rate. Nouveau traitement de l'hypertension portale,Presse Med. 69: 733, 1961.

    Google Scholar 

  17. Bourgeon, R., Catalano, H., Guntz, M. et Domenech, A.: Les problémes chirurgicaux posés par les tromboses et interruptions splénoportales de l'adulte,J. Chir. 82: 643, 1961.

    CAS  Google Scholar 

  18. Bourgeon, R., Catalano, H., Guntz, M. et Castellani, H.: La transposition thoracique de la rate dans certain hypertensions portales de l'enfant,Pediatrie 17: 316, 1962.

    PubMed  CAS  Google Scholar 

  19. Burchell, A.R., Moreno, A.H., Panke, W.F. and Nealon, T.F.: Hemodynamic variables and prognosis following portacaval shunts,Surg. Gynecol. Obstet. 138: 359, 1974.

    PubMed  CAS  Google Scholar 

  20. Burchell, A.R., Moreno, A.H., Panke, W.F. and Nealon, T.F.: Hepatic artery flow improvement after portacaval shunt: A single hemodynamic clinical correlate,Ann. Surg. 184: 289, 1976.

    PubMed  CAS  Google Scholar 

  21. Börjesson, B.: Subcutaneous transposition of the spleen,Bull. Dept. Surg. Lund No 11: 289, 1977.

    Google Scholar 

  22. Börjesson, B., Cavallin-Ståhl, E., Lundh, B., Mercke, C. and Bengmark, S.: Heme catabolism studies in rats after subcutaneous transposition of the spleen. To be publishedJ. Surg. Res. 1977.

  23. Campbell, D.P., Parker, D.E., Anagnostopoulos, C.E.: Survival prediction in portacaval shunts: A computerized statistical analysis,Am. J. Surg. 126: 748, 1973.

    Article  PubMed  CAS  Google Scholar 

  24. Charters, A.C., Brown, B.N., Sviolka, S.C., Knox, D.G. and Orloff, M.J.: The influence of portal perfusion on the response to portacaval shunt,Am. J. Surg. 130: 226, 1975.

    Article  PubMed  Google Scholar 

  25. Clatworthy, H.W., Wall, T. and Watman, R.N.: A new type of portal-to-systemic venous shunt for portal hypertension,Arch. Surg. 71: 588, 1955.

    Google Scholar 

  26. Conn, H.O.: Therapeutic portacaval anastomosis: To shunt or not to shunt,Gastroenterology 67: 1065, 1974.

    PubMed  CAS  Google Scholar 

  27. Crafoord, C. and Frenckner, P.: New surgical treatment of varicous veins of the oesophagus,Acta Otolaryngol. 27: 422, 1939.

    Google Scholar 

  28. Crile, G. Jr.: Transesophageal ligation of bleeding esophageal varices.Arch. Surg. 61: 654, 1950.

    Google Scholar 

  29. Denck, H.: Die Versorgung der akuten Blutung bei Leberzirrhose.Wien. Zeitschr. Inn. Med. 51: 118, 1970.

    CAS  Google Scholar 

  30. Drummond, D. and Morison, R.: A case of ascites due to cirrhosis of the liver cured by operation,Br. Med. J. 2: 728, 1896.

    Google Scholar 

  31. Dumont, A.E., Berman, I.R., Stahl, W.M. and Stuart, M.R.: Significance of an enlarged splenic artery in patients with bleeding varices,Ann. Surg. 175: 466, 1972.

    PubMed  CAS  Google Scholar 

  32. Eck, N.V.: On the question of ligature of the portal vein,Voyenno Med. J., 130: 1, 1877. (Transl.Surg. Gynecol. Obstet. 96: 375, 1953).

    Google Scholar 

  33. Ekman, C.A.: Portal hypertension. Diagnosis and surgical treatment,Acta Chir. Scand. Suppl. 222: 289, 1957.

    Google Scholar 

  34. Everson, T.C. and Cole, W.H.: Ligation of splenic artery in patients with portal hypertension,Arch. Surg. 56: 153, 1948.

    PubMed  CAS  Google Scholar 

  35. Hallenbeck, G.A., Wollaeger, E.E., Adson, M.A. and Gage, R.P.: Resuts after portalsystemic shunts in 120 patients with cirrhosis of the liver,Surg. Gynecol. Obstet., 116: 435, 1963.

    PubMed  CAS  Google Scholar 

  36. Hassab, M. A.: Non-shunt operations for portal hypertension without cirrhosis,Surg. Gynecol. Obstet. 131: 648, 1970.

    PubMed  CAS  Google Scholar 

  37. Hoffman, H.L. and Freedlander, S.O.: Supradiaphragmatic transposition of the spleen for portal hypertension,Arch. Surg. 80: 452, 1960.

    PubMed  CAS  Google Scholar 

  38. Hsu, K.-Y.: Portal systemic shunt for portal hypertension: Importance of bromsulphalein retension for prediction of survival,Ann. Surg. 175: 569, 1972.

    PubMed  CAS  Google Scholar 

  39. Hunt, P.S., Johnston, G.W. and Rodgers, H.W.: The emergency management of bleeding oesophageal varices with sclerosing injections,Br. J. Surg. 56: 305, 1969.

    PubMed  CAS  Google Scholar 

  40. Hästbacka, J.: Thoracic transposition of the spleen for portal hypertension. A clinical and experimental investigation,Ann. Chir. Gynaecol. Fenn., 60: suppl. 176, 1971.

    Google Scholar 

  41. Inokuchi, K., Kobayashi, M., Ogawa, Y., Saku, M. and Iwaki, A.: Late results of a left gastric venous-caval shunt for esophageal varices. Analysis of 100 clinical cases,Chir. Gastroent. 9: 275, 1975.

    Google Scholar 

  42. Jackson, F.C.: Therapeutic portacaval shunts: The VA cooperative study after 12 years. American Gastroenterological Association Postgraduate Course on Portal Hypertension and Cirrhosis, New York, May 21, 1973.

    Google Scholar 

  43. Johnston, G.W. and Rodgers, H.W.: A review of 15 years' experience in the use of sclerotherapy in the control of acute haemorrhage from oesophageal varices,Br. J. Surg. 60: 797, 1973.

    PubMed  CAS  Google Scholar 

  44. Kapp, F. and Buess, H.J.: Ösophaguswandsk-lerosierung als Therapie blutender Ösophagusvarizen bei inoperablen Patienten. Vergleichenden Resultate bei 14 behandelten und 14 unbehandelten Patienten,Dtsch. Med. Wochenschr. 98: 2465, 1973.

    Article  PubMed  CAS  Google Scholar 

  45. Lebrec, D., Kotelanski, B. and Cohn, J.N.: Splanchnic hemodynamics in cirrhotic patients with esophageal varices and gastrointestinal bleeding,Gastroenterology 70: 1108, 1976.

    PubMed  CAS  Google Scholar 

  46. Lens, Th.:Ned. Tijdschr, v. Geneeskunde 1: 645, 1892.

    Google Scholar 

  47. Linton, R.R., Ellis, D.S. and Geary, J.E.: Critical comparative analysis of early and late results of splenorenal and direct portacaval shunts performed in 169 patients with portal cirrhosis,Ann. Surg. 154: 446, 1961.

    PubMed  CAS  Google Scholar 

  48. Longmire, W.P., Jr.: The surgical treatment of portal hypertension,California Med. 73: 209, 1950

    PubMed  Google Scholar 

  49. Lunderquist, A. and Vang, J.: Transhepatic catheterization and obliteration of the coronary vein in patients with portal hypertension and esophageal varices,N. Engl. J. Med. 291: 646, 1974.

    Article  PubMed  CAS  Google Scholar 

  50. Lunderquist, A., Owman, T., Börjesson, B. and Bengmark, S.: Isobutyl-2-cyanobucrylate in obliteration of gastric coronary vein and esophageal varices. To be published. 1977.

  51. Maillard, J.N., Clot, P., Coste, T.: Preoperative parameters influencing survival in patients with elective portacaval shunts,Digestion 10: 129, 1974.

    PubMed  CAS  Google Scholar 

  52. Malt, R.A., Szczerban, J. and Malt, R.B.: Risks in therapeutic portacaval and splenorenal shunts,Ann. Surg. 184: 279, 1976.

    PubMed  CAS  Google Scholar 

  53. Marion, P.: Les obstructions portales,Sem. Hop. Paris 29: 2781, 1953.

    PubMed  CAS  Google Scholar 

  54. Mercke, C., Lundh, B., Bengmark, S., Börjesson, B., Simert, G. and Vang, J.: Heme catabolism in liver cirrhosis with portal hypertension after shunt surgery,Scand. J. Gastroent. 12: 473, 1977.

    Article  PubMed  CAS  Google Scholar 

  55. Morison, R.: A case of ascites due to liver cirrhosis treated by operation,Ann. Surg. 38: 361, 1903.

    PubMed  CAS  Google Scholar 

  56. Mutchnick, M.G., Lerner, E. and Conn, H.O.: Effect of portacaval anastomosis on hypersplenism in cirrhosis: A prospective controlled evaluation,Gastroenterology 68: 1070, 1975.

    Google Scholar 

  57. Narath, A.: Über die sukutane Verlagerung des Omentum. Zentralbl. Chir. 32: 833, 1905.

    Google Scholar 

  58. Nissen, R.: Operationen am ösophagus. Stuttgart: Georg Thieme Verlag, 1954.

    Google Scholar 

  59. Nylander, P.E.A. and Turunen, M.: Transposition of the spleen into the thoracic cavity in cases of portal hypertension,Ann. Surg. 142: 954, 1955.

    PubMed  CAS  Google Scholar 

  60. Paquet, K.J. and Engel, C.: Die Wandsklerosierung des Ösophagusvarizenblutung under der drohenden Hämorrhagie bei dekompensierter Leberfunktion,Z. Gastroenterol. 12: 395, 1974.

    PubMed  Google Scholar 

  61. Peters, R.M. and Womack, N.A.: Surgery of vascular distortions in cirrhosis of the liver,Ann. Surg. 154: 432, 1961.

    PubMed  CAS  Google Scholar 

  62. Rehnström, S., Simert, G., Hansson, J.A., Johnson, G. and Vang, J.: Chronic hepatic encephalopathy. A psychometrical study,Scand. J. Gastroent. 4.

  63. Resnick, R.H., Iber, F.L., Ishihara, A.M. and the Boston Interhospital Liver group: A controlled study of the therapeutic portacaval shunt,Gastroenterology, 67: 843, 1974.

    PubMed  CAS  Google Scholar 

  64. Turner, J., Cuschieri, A., Shields, R. The prediction of the outcome of portacaval shunt using bromsulphtalein (BSP): A retrospective aspect,Br. J. Surg. 61: 828, 1974.

    PubMed  CAS  Google Scholar 

  65. Turunen, M. and Laitinen, H.: Collateral circulation between a spleen transposited into the thoracic cavity and the vena cava superior,Ann. Surg. 149: 443, 1959.

    PubMed  CAS  Google Scholar 

  66. Turunen, M., Pasila, M. and Sulamaa, M.: Transponierung der Milz in die Brusthöhle zur Behandlung von durch Pfortaderstauung verursachten Oesophagialblutungen, II. Weltkongress für Gstroenterologie, München 1962; III: 478, 1963.

    Google Scholar 

  67. Turcotte, J. G., Lamberg, M.J. Variceal hemorrhage, hepatic cirrhosis and portacaval shunts,Surgery, 73: 810, 1973.

    PubMed  CAS  Google Scholar 

  68. Vang, J., Simert, G., Hansson, J.A., Tylén, U. and Bengmark, S.: Results of a modified distal spleno-renal shunt for portal hypertension,Ann. Surg. 185: 224, 1977.

    PubMed  CAS  Google Scholar 

  69. Voorhees, A.B., Price, J.B. and Britton, R.C.: Portasystemic shunting procedures for portal hypertension. Twenty-six years experience in adults with cirrhosis of the liver,Am. J. Surg. 119: 501, 1970.

    Article  PubMed  Google Scholar 

  70. Vosschulte, K.: Dissektionsligatur des Ösophagus bei Varicen der Speiseröhre infolge Pfortaderhypertonie,Chirurg 28: 186, 1957.

    Google Scholar 

  71. Watson, R.B. Ligation of splenic artery for advanced splenic anemia,Br. Med. J. 1: 821, 1935.

    Article  PubMed  Google Scholar 

  72. Rueff, B. and Maillard, J.N.: Portal-systemic shunts in patients with cirrhosis. The need of controlled clinical trials,Digestion 11: 414, 1974.

    Article  PubMed  CAS  Google Scholar 

  73. Satterfield, J.V., Mulligan, L.V. and Butcher, H.R.: Bleeding esophageal varices. Comparison of operative and nonoperative treatment,Arch. Surg. 90: 667, 1965.

    PubMed  CAS  Google Scholar 

  74. Sedgewick, C.E. and Poulantzas, J.K.: Portal hypertension, Little Brown Co. Boston 1967.

    Google Scholar 

  75. Sugiura, M. and Futugawa, S.: A new technique for treating esophageal varices,J. Cardiovasc. Surg. 66: 677, 1973.

    CAS  Google Scholar 

  76. Simert, G.: Portal hypertension. Studies on the problems of encephalopathy and gastrointestinal bleeding,Bull. Dept. Surg. Lund Nr. 15, 1977.

  77. Simert, G., Persson, T. and Vang, J.: Some factors predicting survival after portacaval shunt. A multiple linear regression analysisAnn. Surg. 187: 174 1978.

    PubMed  CAS  Google Scholar 

  78. Smith, G.V.: Splenectomy and coronary vein ligation for the control of bleeding esophageal varices,Am. J. Surg. 119: 122, 1970.

    Article  PubMed  CAS  Google Scholar 

  79. Takasaki, T., Kobayashi, S., Iwatsuka, M., Suzuki, S., Hayashi, N. and Harada, M.: Treatment of esophageal varices: Our method of esophageal transection using a suture device,Chir. Gastroent. 10: 137, 1976.

    Google Scholar 

  80. Talma, S.: Chirurgische Öffnung neuer Seitenbahnen für das Blut der Vena portae. III. Berl. Klin. Wochenschr. 41: 893, 1904.

    Google Scholar 

  81. Welch, C.S.: Ligation of esophageal varices by transabdominal route,N. Engl. J. Med. 255: 677, 1956.

    Article  PubMed  CAS  Google Scholar 

  82. Whipple, A.O.: Problems of portal hypertension in relation to the hepatosplenopathies,Ann. Surg. 122: 449, 1945.

    PubMed  CAS  Google Scholar 

  83. Witte, C.L., Witte, M.H., Renert, W., O'Mara, R.E. and Lilien, D.L.: Splenic artery ligation in selected patients with hepatic cirrhosis and in Sprague-Dawley rats,Surg. Gynecol. Obstet. 142: 1, 1976.

    PubMed  CAS  Google Scholar 

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    Stig Bengmark

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Bengmark, S. New pathways in portal hypertension surgery. The Japanese Journal of Surgery 9, 1–16 (1979). https://doi.org/10.1007/BF02468710

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