Diminished morbidity and mortality in portal hypertension surgery: Relocation in the therapeutic armamentarium

Although several effective therapeutic options are available for bleeding f rom portal hypertension, surgery has a well-defined role in the management of patients with good liver function who are electively operated. The aim o f this investigation was to evaluate the operative mortality and morbidity of portal blood flow-preserving procedures in a highly select patient popul ation. The records of 148 patients operated on between 1996 and 2000 using one of two techniques (selective shunts or a Sugiura-Futagawa operation [co mplete portoazygos disconnection]) were analyzed with particular attention to operative mortality, postoperative rebleeding, and encephalopathy. Survi val was calculated according to the Kaplan-Meier method. Sixty-one patients had distal splenorenal shunts placed, and 87 patients had a devascularizat ion procedure. Operative mortality for the group as a whole was 1.2%. In th e group with selective shunts, the rebleeding rate was 4.9%, the encephalop athy rate was 9.8%, and the shunt obstruction rate was 1.6%. Survival at 24 months was 94% and at 48 months was 92%. In those undergoing devasculariza tion, the encephalopathy rate was 5% and the rebleeding rate was 14%. Survi val at 24 months was 90% and at 48 months was 8%. Portal blood flow-preserv ing procedures have very low morbidity and mortality rates at specialized c enters. In addition, a low rebleeding rate is associated with a good qualit y of life. Low-risk patients with bleeding portal hypertension should be co nsidered for surgical treatment.