Background;Surgery for portal hypertension has alow rebleeding rate. Patients that rebleed can begrossly divided into those who die as a consequenceof the episode, those who don't die but develop liverfailure (remaining as Child-Pugh C) and those who,in spite of the bleeding episode, retain good liverfunction (Child-Pugh A or B). At our hospital, thelatter group is considered for further surgicaltreatment. We report here the results of surgicalrescue of surgical failures.Methods;In a twenty year period, 36 patients (30Child-Pugh A, 6 Child-Pugh B) were reoperated. Thefiles of these patients were reviewed.Results;Average age was 33 years. Cirrhosis waspresent in 31 cases. All patients were electivelyreoperated with portal blood flow preserving procedures.Operative mortality for the whole groupwas 12% and for the Child-Pugh A group 6.6%. Rebleedingwas observed in 5.5%. Postoperativeincapacitating encephalopathy was recorded in onecase (2.7%). Good quality of life was recorded in 84%of the cases. Survival (Kaplan-Meier) was 78% at 6months and 69% at 5 years.Conclusions;Surgical failures in low risk patients(Child-Pugh A or B) can be treated by means ofsurgery, and a low mortality, re-bleeding andencephalopathy rate can be expected. The performanceof a portal blood flow preserving procedureis recommended.
展开▼
