Selective Esophagogastric Devascularization in the Modified Sugiura Procedure for Patients with Cirrhotic Hemorrhagic Portal Hypertension: A Randomized Controlled Trial

Early Experience with Surgical Management of Non-Cirrhotic Portal Hypertension in Nigeria: Report from a Single Centre

Introduction

Portal hypertension is characterised by an increase in portal pressure. It may be a result of cirrhosis of the liver or non-cirrhotic hepatic and portal vein diseases. Non-cirrhotic portal hypertension (NCPH) is caused by a heterogeneous group of diseases affecting the liver and extrahepatic locations. In our setting, the most common cause of NCPH is schistosomiasis. We describe our experience in the surgical management of NCPH.

Materials and Methods

This is a single centre retrospective study of all patients who had surgery for NCPH from January 2015 to December 2023 was retrieved for data collection. Data collected included the cause of portal hypertension, age, gender, indication for surgery, type of surgery, and outcome of surgery. Data were analysed using SPSS version 26.

Results

A total of 13 patients had surgery for NCPH. The most common cause of NCPH was hepatosplenic schistosomiasis in 10 patients, whereas the remaining 3 patients had idiopathic NCPH. The indication for surgery was upper gastrointestinal bleeding secondary to oesophageal varices refractory to endoscopic therapy. The surgical intervention of choice includes the modified Sugiura procedure in five patients and the Hassab procedure in eight patients. Variceal rebleeding was seen in two patients within 1 year of surgery (15%) and in only three patients within 3 years of surgery (23%).

Conclusion

Surgical treatment of NCPH is associated with good outcomes in patients with failed endoscopic therapy.

The Portosystemic Shunt for the Control of Variceal Bleeding in Cirrhotic Patients: Past and Present

Based on an experience of more than 50 years in the treatment of portal hypertension (PHT), the authors review and analyze the evolution of the surgical portocaval shunt (PCS). We would like to provide an insight into the past of PCS, in order to compare it with the current state of the treatment of PHT complications. As a landmark of the past, we shall present statistics of more than 500 cases of PHT operated between 1968 and 1983. From this group, 238 patients underwent surgical portocaval shunting during a fifteen-year period. The behavior of the portal hemodynamics following PCS was studied and the postoperative decrease in portal pressure (PP), as well as the residual PP, were recorded. The portal manometric determinations were made by electronic recordings using the Hellige device and direct intraoperative recordings through the catheterization of a ramus in the portal area. The results of PCS are superposable, in terms of hemodynamic efficiency, with those of the intrahepatic shunt (TIPS-transjugular intrahepatic portosystemic shunt). The authors discuss the current place of PCS, in obvious decline in comparison with the situation 50 years ago. The current methods of controlling variceal bleeding represent obvious progress. PCS remains with very limited indications, in specific situations when the other therapeutic methods have failed or are not recommended.