Surgical Treatment Results of Extrahepatic Portal Hypertension

Aim of the study was to evaluate in a comparative aspect the efficiency of various methods of preventing hemorrhagic syndrome in patients with extrahepatic portal hypertension. Material and methods. The study included 131 patients with various forms of extrahepatic portal hypertension, who underwent surgical prevention of recurrent bleeding from varices in the Republican Specialized Scientific and Practical Medical Center for Surgery named after academician V.Vakhidov for the period from 2006 to 2020. The majority of patients were at adolescence (41,2%) and young (45,0%) ages. Total dissociation of the gastro-esophageal collector was performed in 57 (43.5%) patients, portosystemic bypass surgery – in 51 (38.9%) patients and endoscopic interventions – in 23 (17.6%) cases. Results. In 48.1% of cases, a good result was obtained in one stage of treatment, in 16.8% patients additional sessions of endoscopic interventions were required. The best results were obtained with portosystemic bypass surgery. In general, the proportion of successful treatment was 82.4%. The comparative frequency of recurrent bleeding showed a significantly low efficiency of endoscopic interventions, in which repeated episodes of hemorrhagic syndrome were developed in 65.2% of patients after an average of 13.5±2.9 months. The total dissociation of the gastroesophageal collector provided a relapse-free course lasting 25.9±4.4 months (p<0.05) in 35.1% of cases (p=0.014). Conclusion. The efficiency of the methods used to prevent bleeding from varicose veins of the esophagus and stomach in extrahepatic portal hypertension at one stage of treatment made up only 48.1%. At the same time, the most difficult categories were portal system thrombosis and splenoportal thrombosis with good results of single-stage or combined surgical approaches in 60% of cases. At the cavernous transformation of the portal vein this indicator was 65.0%, isolated thrombosis of the splenic vein - 71.4% and portal vein thrombosis - 73.5%.