Background: Nowadays, bleeding due to rupture of esophageal vein is common severe complication of portal hypertension syndrome. Spleno-renal vein anastomoses are useful procedure in the prevention of recurrent bleeding but there are some disadvantages. Objectives: To evaluate results of splenectomy, spleno-renal vein anastomoses in the prevention of recurrent bleeding due to portal hypertension at GI Emergency Department, Viet Duc Hospital. Subjects and method: This intervention study was carried out on 34 patients with bleeding due to rupture of esophageal vein in cirrhosis and portal hypertension. All patients underwent splenectomy, spleno-renal vein anastomoses. Mortality rate, recurrent bleeding, and anastomotic flow were assessed. Results and Conclusion: 34 patients (29 males and 5 females) with Child A and B cirrhosis underwent splenectomy and spleno-renal vein anastomoses. These procedures can prevent 88% of recurrent bleeding due to rupture of esophageal vein in cirrhosis and portal hypertension after 18 months of follow-up. 12% patients had recurrent bleeding. The number of patients with postoperative hepato-cerebral syndrome was small. The anastomotic stricture rate was suitable.
Splenectomy ; Fibrosis/ surgery ; Hypertension ; Portal ;

We here report 3 cases successfully treated with transjugular intrahepatic portosystemic shunt using Viatorr stent. The 3 patients were had a diagnosis of liver cirrhosis with portal vein hypertension, and presented with black stool and hematemesis. After the treatment, the patients' portal vein pressures were decreased without black stool or hematemesis. Our success demonstrate the feasibility of using Viatorr stent in transjugular intrahepatic portosystemic shunt.
Humans ; Hypertension, Portal ; surgery ; Liver Cirrhosis ; surgery ; Portal Vein ; Portasystemic Shunt, Transjugular Intrahepatic ; Stents

Portal hypertension (PHT), as a disease with high incidence all over the world, badly affects the patients' health. The research on hemodynamics plays an important role in exploring the pathogenesis of PHT, assessing the risk of hemorrhage induced by the complications, selecting the scheme and time of surgical operations as well as evaluating the curative effects of medication. In this article, the main factors in the pathogeny of PHT are reviewed and the surgical treatments are discussed from the hemodynamic viewpoint. Then some recent results in the hemodynamic research of PHT are summarized. In addition, main ideas are put forward as to establishing a new global biomechanical model of PHT.
Animals ; Hemodynamics ; Humans ; Hypertension, Portal ; etiology ; physiopathology ; surgery ; Models, Cardiovascular

Hemodynamics ; Humans ; Hypertension, Portal ; physiopathology ; surgery ; Portal Vein ; physiopathology ; Portasystemic Shunt, Surgical ; methods

Humans ; Hypertension, Portal ; surgery ; Liver ; pathology ; surgery ; Liver Failure ; surgery ; Liver Neoplasms ; surgery ; Liver Transplantation

Adolescent ; Adult ; Child ; Child, Preschool ; Humans ; Hypertension, Portal ; surgery ; Male ; Portal Vein ; surgery ; Vascular Grafting ; methods ; Young Adult

Hemodynamics ; Humans ; Hypertension, Portal ; etiology ; physiopathology ; surgery ; Liver Cirrhosis ; complications ; physiopathology ; surgery ; Liver Transplantation ; Postoperative Period

Humans ; Hypertension, Portal ; etiology ; surgery ; Liver Cirrhosis ; complications ; surgery ; Liver Transplantation ; Portasystemic Shunt, Surgical ; methods

This study was aimed to explore prevention and treatment of hemorrhage during laparoscopic splenectomy plus devascularization (LSD) for portal hypertension by modified and simplified operation. From June 2012 to June 2014, LSD was performed on 138 patients with portal hypertension. The patients were allocated into two groups: earlier stage (ES) group, in which 45 patients received traditional LSD from June 2012 to Sep. 2012; later stage (LS) group, in which 93 patients underwent modified LSD from Jan. 2013 to June 2014. Perioperative variables were compared between the two groups. Laparoscopic operations were successfully performed in all but two patients in ES group who were converted to laparotomy (total conversion rate: 1.4%). There was no perioperative death or reoperation, and all patients recovered and were discharged from hospital with no serious complications in the six months of postoperative follow-up. The average time in the ES group was longer than that in the LS group (335.1 min vs. 201.3 min, P<0.05). LS group outperformed ES group in terms of blood loss (705.4 mL vs. 910.4 mL, P<0.05). The average operation time to oral diet intake after surgery (40.5 h vs. 50.3 h, P<0.05) and postoperative hospital stay (7.4 d vs. 9.0 days, P<0.05) were much less in the LS group than in the ES group. The overall complication rate (4.3 % vs. 11.1 %, P<0.05) and conversion rate (0% vs. 4.4%, P<0.05) were lower in the LS group than in the ES group. It was concluded that prevention and treatment of hemorrhage are the key points of LSD for portal hypertension. By creating a tunnel above the splenic pedicle and a tunnel behind the lower esophagus, the simplified and modified LSD can reduce hemorrhage and improve success of surgery dramatically, and splenomegaly and severe varices are not contraindications.
Adult ; Female ; Hemorrhage ; prevention & control ; surgery ; Humans ; Hypertension, Portal ; surgery ; Male ; Middle Aged ; Splenectomy

OBJECTIVESTo investigate intestinal permeability in patients with portal hypertension and to search for a relationship with portal pressure.

METHODSTwenty patients with portal hypertension were divided two groups (A, B), 10 patients per group. In group A patients were treated with combined TIPS and modified Sugiura. In group B, patients were treated with modified Sugiura only. Intestinal permeability was assessed before operation, two weeks after TIPS, and two weeks after modified Sugiura, and 20 healthy control subjects were also assessed.

RESULTSIntestinal permeability was significantly higher in patients with portal hypertension than in healthy controls (0.132 +/- 0.110 vs. 0.032 +/- 0.018, P < 0.01). In group A, portal pressure and intestinal permeability decreased two weeks after TIPS (P < 0.05) and no obvious change was noted two weeks after modified Sugiura; but they were significantly lower than those before TIPS (P < 0.05). In group B intestinal permeability was not different before and after operation. Intestinal permeability in group A was not different from that in group B before treatment, but significantly lower after modified Sugiura (P < 0.05). Portal pressure was significantly correlated with intestinal permeability (r = 0.627, P < 0.01).

CONCLUSIONSThis study shows that combined TIPS and modified Sugiura can lower portal pressure and intestinal permeability, and enhance the therapeutic efficacy on portal hypertension.

Female ; Humans ; Hypertension, Portal ; physiopathology ; surgery ; Intestines ; physiopathology ; Male ; Middle Aged ; Permeability ; Portal Pressure ; physiology ; Portasystemic Shunt, Surgical