Portal Hypertension Operation

It encompasses a group of disorders characterized by normal liver functions and structure but with symptoms of portal hypertension usually bleeding or bile duct blockage. The most common ones in clinical practice are EHPVO (Extrahepatic portal venous obstruction) and NCPF (Non-Cirrhotic portal fibrosis). Since liver structure and functions are normal, these do not require liver transplantation.

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They usually need treatment for gastrointestinal bleeding/ bile duct blockage. Many are asymptomatic and are incidentally found when being evaluated for some other illness and they may or may not need treatment depending on clinical scenario.

The initial treatment would include endoscopic ones- for esophageal/ gastric varices or biliary stents for jaundice. Presence of symptomatic spleen enlargement/ problematic hyperfunctioning spleen with low platelet and white cell counts/ GI bleeding inspite of endoscopic treatments/ presence of ectopic varices beyond stomach/ bile duct blockage needs surgical treatment. The usual surgical treatment is Splenectomy +/_ porto-caval shunts (common ones are spleno-renal or meso-caval shunt). Here, splenic vein from the high-pressure system is joined to kidney veins which are low-pressure ones. This would reduce pressures in the portal vein and reduce the risks of bleeding and/ or bile duct blocks. 

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Fluoroscopic picture of transjugular intrahepatic portosystemic shunt

Specific shunts select a non-digestive streams to be shunted to the fundamental venous seepage while passing on the gastrointestinal venous waste to keep on going through the liver.

The most notable of this kind is splenorenal. This associates the spleen vein to the left renal vein hence diminishing gateway framework strain while limiting any encephalopathy. In an H-shunt, which could be mesocaval (from the better mesenteric vein than the mediocre vena cava) or could be, portocaval (from the entryway vein to the substandard vena cava) a join, either manufactured or the favored vein gathered from somewhere else on the patient’s body, is associated between the predominant mesenteric vein and the second rate vena cava. The size of this shunt will decide how particular it is.