Treatment for Portal Hypertension

Shunji Futagawa

Second Department of Surgery, Juntendo University School of Medicine

The treatment for portal hypertension have been developed as a surgery for portal system. Although portosystemic shunt was employed at the begining of the surgery, a high incidence (36. 4%) of hepatic encephalopathy, so-called the Eck fistula syndrome, was observed in 110 patients who underwent this procedure. Afterwards, it was proved that this type of encephalopathy disappeared through the closure of the shunt. As a result, the closure of the shunt was actively performed. In view of poor quality of life, nonshunting operations, especially esophageal transection, came into prominence in place of shunting operation. In our department a total of 576 patients had a nonshunting operation for esophagogastric varices, including 413 cases of transthoracic esophageal transection with paraesophagogastric devascularization (Sugiura procedure), 40 cases of trans-abdominal esophageal transection and 123 cases of Hassab's procedure. We have obtained nearly satisfactory results showing 9.5% of cumulative recurrent rates at 10 years after surgery. Subsequently, the introduction and the spread of endoscopic injection sclerotherapy (EIS) have made dramatic changes in a treatment for esophagogastric varices. Nowadays it has been most popularized instead of surgical procedures because of less invasiveness. In addition, endoscopic variceal ligation (EVL), transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (B-RTO) as techniques of interventional radiology for portal hypertension have been recently applied. In consideration of incurable cases and a high incidence of recurrence under these non-surgical treatments, however, surgical treatments have still played an important part in the treatments for portal hypertension. In conclusion, it is considered that the cases which are expected to have a long-term prognosis, such as a case of idiopathic portal hypertension (IPH), extrahepatic portal obstruction (EHO) and liver cirrhosis of Child A group should be treated by surgical procedures.

Key words
portal hypertension, portosystemic shunt, Sugiura procedure, Hassab's procedure, endoscopic injection sclerotherapy

Reprint requests
Shunji Futagawa Second Department of Surgery, Juntendo Uneversity School of Medicine 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 JAPAN

Accepted
January 27, 1999

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