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portal-systemic shunt procedures

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The use of portal-systemic shunt procedures for the treatment of acutely bleeding oesophageal varices is now reserved for the 5-10% of patients who fail to respond to pharmacotherapy or sclerotherapy.

Portal-systemic shunts have a high intraoperative mortality and a poor 5 year survival, particularly in patients with significant hepatic decompensation. The most common problem is chronic hepatic encephalopathy.

There are two types of portal-systemic shunt procedures:

  • non-selective procedures:
    • the whole portal system is decompressed
    • include the end-to-side and the side-to-side porta-caval shunts
    • carry a high risk of hepatic encephalopathy

  • selective procedures:
    • only decompress the oesophagogastric venous network
    • have a lower risk of encephalopathy
    • include the spleno-renal and the left-gastric -inferior venal cava shunts

Transjugular intrahepatic portal-systemic shunting (TIPSS) is a new procedure which is particularly useful in the treatment of acutely bleeding oesophageal varices if liver transplantation is being considered.

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