Portal hypertensive bleeding: The place of portosystemic shunting

Knechtle SJ, Galloway JR. (2017) Chapter 85. Portal hypertensive bleeding: The place of portosystemic shunting. Ed.: Jarnagin WR, In Blumgart’s Surgery of the Liver, Biliary Tract and Pancreas, 2-Volume Set (6th ed.), Elsevier, pgs. 1218-1230.e3.

“We consider the current role of surgical shunts to be (1) less frequent than in the previous era; (2) of benefit in the emergency setting when other modalities—including medical therapy, endoscopic control, or TIPS—have failed; (3) useful in the elective setting as a long-term bridge to liver transplantation; (4) useful in the elective setting as definitive therapy for patients with noncirrhotic portal hypertension or CTP class A cirrhosis; and (5) a beneficial treatment for Budd-Chiari syndrome. We prefer the selective distal splenorenal shunt in patients without ascites because of its lower risk of portosystemic encephalopathy and its potential for preserving portal blood flow.” (p. 1230)

For reference:

Blumgart’s Surgery of the Liver, Biliary Tract and Pancreas (ClinicalKey)

Blumgart’s Video Atlas: Liver, Biliary & Pancreatic Surgery (ClinicalKey)

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