The evolution of portal hypertension surgery - Lessons from 1000 operations and 50 years' experience

Hypothesis: Surgery for portal hypertension has evolved widely in the past decades. Selection criteria and the type of operations have evolved because of the appearance, of other therapeutic alternatives, such as pharmacother apy, endoscopic therapy, transjugular intrahepatic portosystemic shunt, and liver transplantation. We believe the surgical approach has a therapeutic role in a select patient population. Design: Retrospective review of the medical records of patients operated on for bleeding portal hypertension in the past 50 years. Setting: An academic tertiary care university hospital. patients and Methods: In a 50-year period, 1000 operations for the treatmen t of bleeding portal hypertension have been done, including shunts and deva scularization procedures. In the past years, in low-risk (Child-Pugh classi fication A) selected patients, only portal blood flow-preserving operations have been done. Results: Non-portal blood flow-preserving procedures had a wide spectrum of results, with a high encephalopathy rate and short long-term survival. The results with portal blood flow-preserving procedures in the past 10 years are as follows: operative mortality, 2.7%; postoperative encephalopathy, 6% ; rebleeding, 6%; and shunt obstruction, 4%. Conclusions: Portal hypertension surgery has a role in elective operations and in low-risk selected patients, when portal blood flow-preserving proced ures are done. The type of operation is selected according to the individua l characteristics of each patient.