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Is there still a role for surgery in bleeding portal hypertension?

Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 246–247 (2005)Cite this article

For centuries, gastrointestinal bleeding has been recognized as a major cause of morbidity and mortality in patients with pathology of the portal circulation. By contrast, a fuller understanding of the pathophysiology of portal hypertension and variceal hemorrhage has occurred only over the past three decades. This has led to significant advances in therapies for the prevention and treatment of bleeding in portal hypertension. As more-effective therapies evolve, the role of the surgeon may be considered to be in question, or in evolution.

In the US, portal hypertension is most commonly caused by alcoholic cirrhosis, but it is increasingly seen secondary to hepatitis C. Increased resistance in the portal vascular system can also occur for many other reasons, such as portal-vein thrombosis, leading to portal hypertension and the risk of variceal bleeding. The incidence of gastroesophageal varices in cirrhotic patients is ∼50%, and bleeding from them causes death in up to one-third of patients with cirrhosis. Without intervention, only 50% of acute bleeding episodes achieve hemostasis, and the risk of early and late rebleeding is extremely high.1

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Authors and Affiliations

  1. Professor of Surgery Cleveland Clinic Foundation, Cleveland, OH, USA

    J Michael Henderson

  2. Clinical Fellow, at the Cleveland Clinic Foundation, Cleveland, OH, USA

    Yolanda Yang

Authors
  1. J Michael Henderson
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  2. Yolanda Yang
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Correspondence to J Michael Henderson.

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The authors declare no competing financial interests.

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Henderson, J., Yang, Y. Is there still a role for surgery in bleeding portal hypertension?. Nat Rev Gastroenterol Hepatol 2, 246–247 (2005). https://doi.org/10.1038/ncpgasthep0192

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