[The evolution of surgery for extrahepatic portal hypertension].
30 years' experience of elective surgical treatment of 600 patients with extrahepatic portal hypertension is summarized. Insufficient effectiveness of splenectomy in bleeding from varicose veins (VV) of the stomach and the esophagus (40% of relapses) is shown as well as frequent development (25%) of asplenic hemorrhagic thrombocytopenia. Partial esophagogastrectomy also has failed initial hopes due to severe agastric anemia which developed in 49.6% patients and relapses of erosion and ulcerogenous hemorrhage from the gastric stump (30%). Introduction of microsurgical methods, contemporary suturing material, usage of the jugular vein's segment for performing H-shape anastomoses enabled in the last decade to carry out porto-caval shunt using distal segments of superior mesenteric vein with diameter 5-9 mm and thus to increase the number of radical operations to thoroughly rehabilitate the patients, and to decrease postoperative mortality rate from 11.1% to 0.7% as well. Vascular anastomoses were not feasible, the operation of choice may be suturing of VV of the esophagus and the stomach with subsequent endoscopic sclerosis formation.
A K
AK
Eramishantsev
V M
VM
Lebezev
D004932:Esophageal and Gastric Varices / Q000601:surgery; D016629:Esophagectomy; D005743:Gastrectomy; D006782:Hospitals, Special; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D009031:Moscow; D010166:Palliative Care; D011170:Portasystemic Shunt, Surgical / Q000379:methods / Q000639:trends*; D013156:Splenectomy