Update on Shunt Surgery

Abstract

Background: Bleeding from esophagogastric varices is a life-threatening complication from portal hypertension. It occurs in 15% of patients and has a mortality rate of 20-35%.

Summary: The primary therapy for variceal bleeding is medical. In cases of recurrent bleeding, a definitive therapy is required. In cases of parenchymal decompensation, liver transplantation is the causal therapy, but if liver function is preserved, portal decompression is the therapy of choice. The use of the transjugular intrahepatic portosystemic shunt (TIPS) has achieved widespread acceptance, although evidence for surgical shunts is comparable or better in patients with good hepatic reserve. The type of surgical shunt depends on the patent veins of the portomesenteric system. If total occlusion is present, a devascularization procedure might be indicated.

Key messages: Therapy, taking into account liver function, morphology of the portovenous system, and imminent liver transplantation, should be performed by an interdisciplinary team of gastroenterologists, interventional radiologists, and gastrointestinal surgeons.

Keywords: Cirrhosis; Esophageal varices; Portal hypertension; Portal/mesenteric vein thrombosis; Surgical portocaval shunt.

Fig. 1

Algorithm for the secondary prophylaxis of variceal bleeding (modified according to Glowka et al. [1]). NSBB, nonselective β-blockers; Child, Child-Pugh class.