Laparoscopic division of a portosystemic shunt to treat chronic hepatic encephalopathy.
In the event of liver cirrhosis with severe portal hypertension, voluminous portosystemic shunt may lead to refractory encephalopathy. Obliteration of the shunt has been described as a satisfactory therapeutic solution, and reported procedures are mainly endovascular embolization and surgical shunt ligation through laparotomy. The former procedure is less invasive and seems to be as efficient. Laparoscopy, which is widely recognized to minimize mortality and morbidity in cirrhotic patients undergoing surgery, has never been used for such a procedure. Shunt division can therefore be considered using this modern approach to good effect and reduced morbidity. In support of this view, we report a case of severe chronic encephalopathy cured by laparoscopic surgical division of a large shunt after failure of the percutaneous technique.
Seman
Marie
M
Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.
Scatton
Olivier
O
Zalinski
Stephane
S
Chrissostalis
Ariane
A
Legmann
Paul
P
Soubrane
Olivier
O
Ann Surg. 2006 Apr;243(4):499-506
16552201
Ann Surg. 1983 Apr;197(4):422-6
6600914
Radiology. 1987 Dec;165(3):721-5
3685350
World J Surg. 1991 Jan-Feb;15(1):109-13; discussion 113-4
1994594
Surg Laparosc Endosc Percutan Tech. 2007 Jun;17(3):212-4
17581471
Hepatogastroenterology. 2003 Jul-Aug;50(52):1128-32
12845996
Am J Surg. 1981 Aug;142(2):285-9
7258542
World J Surg. 2004 Jan;28(1):23-8
14648045
Hepatogastroenterology. 2001 May-Jun;48(39):840-1
11462936
Cardiovasc Intervent Radiol. 1997 Mar-Apr;20(2):120-4
9030502
Abdom Imaging. 2000 Nov-Dec;25(6):567-71
11029085
Ann Surg. 1995 May;221(5):459-66; discussion 466-8
7748027
J Am Coll Surg. 2003 Feb;196(2):236-42
12595052
Hepatology. 2005 Nov;42(5):1158-65
16250033