Laparoscopic division of a portosystemic shunt to treat chronic hepatic encephalopathy

Abstract

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.

Keywords: Encephalopathy; Portosystemic shunt; laparoscopy.

Figure 1.

(a) Preoperative CT scan showing the shunt forming by re-permeabilization of the umbilical vein to the iliac vein. (b) Postoperative CT scan showing disconnection of the shunt and disappearance of the latter.

Figure 2.

(a) Operative view of the shunt. To avoid uncontrolled bleeding, two cords (white arrows) were introduced percutaneously to secure the shunt dissection. (b) Operative view after disconnection of the shunt using a vascular stapler.