Bypass surgery for portal hypertension

Surgery to treat portal hypertension is one of the effective methods being applied today in the treatment of portal hypertension. This bypass surgery is carried out on the basis of creating a bridge between the portal vein and the inferior vena cava, helping patients to minimize portal hypertension.

The anatomy of the portal vein consists of 3 main parts as follows:
Splenic vein: Having blood supply from the spleen, stomach and pancreas, occupying about 1/3 of the portal vein. Inferior mesenteric vein: The blood supply is the left colon with blood from the rectum. Superior mesenteric vein: With blood supply from the small intestine, the right 1⁄2 of the colon along with the pancreas and stomach. The splenic vein and the inferior mesenteric vein join together at a location called the bi-mesenteric venous body, and then join with the superior mesenteric vein to form the portal vein trunk in a transverse position. First lumbar vertebra on the right side. The trunk of the portal vein is further divided into two main parts, the lower part is posterior to the pancreas and the upper part enters the stalk of the liver. One of the most important parts of the portal vein is the coronary vein. In terms of structure, the portal vein has a smooth and thin structure, so when subjected to a pressure exerted on it, it will cause portal vein disease. Because the internal structure of the vein does not contain a valve, if the vein is blocked, it will lead to the phenomenon of blood reflux into the vena cava.

Portal hypertension is a condition in which the hepatic venous pressure gradient is > 5 mmHg, usually a consequence of cirrhosis of the liver. The cause of portal hypertension may be cirrhosis of the liver, which leads to increased blood flow to the viscera causing splanchnic varicose veins. Portal hypertension is classified by location as follows:
Anterior hepatic portal hypertension including portal vein thrombosis, splenic vein thrombosis and Banti syndrome Hepatic portal hypertension including hypertension portal vein force in front of the sinuses and cirrhosis of the liver at birth. Sinus portal hypertension, including cirrhosis, or alcoholic hepatitis, Posterior portal hypertension, including Budd-Chiari syndrome and hepatic inferior vena cava occlusion. Some typical symptoms of portal hypertension are as follows:
Splenomegaly is the most typical and common symptom, in some cases the spleen is very enlarged, classified as grade IV or V splenomegaly. Systemic symptoms are evident when the patient is in a sitting position. Hemorrhoids are caused by tension in the anastomosis around the rectum, but this is not a common symptom of portal hypertension. Ascites Gastrointestinal bleeding due to varicose veins at the site of the annular vena cava and portal vein, usually bleeding in the lower third of the esophagus and stomach Laboratory techniques help diagnose hypertension The portal vein is:
esophagogastroduodenoscopy to detect gastrointestinal bleeding to suspect the possibility of portal hypertension. Angiography of the mesenteric and visceral arteries if endoscopy does not give clear results. Contrast esophagogram X-ray of the spleen and portal vein X-ray of the liver at a distance to investigate the size of the liver Static pressure measurement Portal bronchoscopy, perform liver biopsy test to evaluate cirrhosis in patients. Prompt surgical method Determination of blood Bilirubin to assess liver function Blood test The most common complication of portal hypertension are esophageal varices, gastrointestinal bleeding, ascites, overactive spleen. more, liver encephalopathy, bacterial peritonitis, liver and kidney diseases such as hepatocellular carcinoma... Therefore, it is necessary to diagnose portal hypertension at the earliest to have measures to treat edema. unify.

Treatment of portal hypertension has the goal of reducing portal pressure, treating complicated diseases, treating bleeding due to esophageal varices, treating ascites... In which, Surgical bypass of the portal vein and inferior vena cava is the main method to reduce portal pressure, reducing the risk of dangerous complications, including varicose veins of the stomach and esophagus.
Patients who have been diagnosed with portal hypertension, have ever had gastrointestinal bleeding caused by portal vein disease, have symptoms of esophageal varices along with laboratory tests. If the liver function is still good, then there will be indications for bypass surgery. For cases of portal vein occlusion, severe ascites as well as liver damage, liver failure, this surgery is absolutely not performed. Before the bypass surgery, the patient needs to be treated so that the liver function returns to normal and the patient's general condition must be stable before being allowed to proceed with the surgery.
The steps of the surgical method of bypassing the portal vein and inferior vena cava include:
Place the patient in a supine position, with a pillow across the abdomen. General anesthesia endotracheal, at the same time measuring electrocardiogram and monitoring SpO2 continuously during surgery. Place central and peripheral venous lines Set up oxygen machines to support breathing for patients Insert urinary catheters . Make an abdominal incision at the left lower rib line. Identify the portal vein, vena cava and abdominal collateral circulation to assess the lesion. Dissection reveals inferior vena cava, caudal lobe of liver can be removed if necessary. Portal vein dissection at the hepatic peduncle, pulls the common bile duct to expose portal vein from the hilum of the liver to the superior border of the pancreas. Use a vein from the patient's body or an artificial vessel to create a bridge between the exposed portal vein and the exposed vena cava. Sew with Prolene 6/0, 7/0 sutures with the shortest possible anastomosis Check blood flow Inside, portal pressure is measured to see how well blood is flowing after bypass surgery. Hemostasis for the patient at the surgical site and the vascular anastomosis Place the drainage Close the abdominal cavity in the sequence of anatomical layers Some complications and management need attention after bypass surgery to treat hypertension Portal venous force is:
Monitor consciousness and vitals Do blood tests, Hematocrit after about 15-30 minutes of resuscitation Measure central venous pressure of the patient Measure respiratory function, check status of drainage and urine about once an hour, pay attention to urine volume and urine color. Antibiotic treatment for venous infections Give blood transfusions, use pain relievers if necessary Prevent stomach ulcers in patients Prothrombin test, inject vitamin K into the patient. If there is bleeding after surgery, it is necessary to monitor and consider re-surgery. . If the ascites returns, the patient should take diuretics, liver tonics and limit sodium.

Treatment of portal hypertension is complex, including the treatment of many of the problems associated with portal hypertension and its complications such as esophageal varices or recurrent ascites. Therefore, after the bypass surgery, the patient needs to be monitored and taken care of so that he can recover as soon as possible.
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