Background; Surgery for portal hypertension has a
low rebleeding rate. Patients that rebleed can be
grossly divided into those who die as a consequence
of the episode, those who don't die but develop liver
failure (remaining as Child-Pugh C) and those who,
in spite of the bleeding episode, retain good liver
function (Child-Pugh A or B). At our hospital, the
latter group is considered for further surgical
treatment. We report here the results of surgical
rescue of surgical failures.
Methods; In a twenty year period, 36 patients (30
Child-Pugh A, 6 Child-Pugh B) were reoperated. The
files of these patients were reviewed.
Results; Average age was 33 years. Cirrhosis was
present in 31 cases. All patients were electively
reoperated with portal blood flow preserving procedures.
Operative mortality for the whole group
was 12% and for the Child-Pugh A group 6.6%. Rebleeding
was observed in 5.5%. Postoperative
incapacitating encephalopathy was recorded in one
case (2.7%). Good quality of life was recorded in 84%
of the cases. Survival (Kaplan-Meier) was 78% at 6
months and 69% at 5 years.
Conclusions; Surgical failures in low risk patients
(Child-Pugh A or B) can be treated by means of
surgery, and a low mortality, re-bleeding and
encephalopathy rate can be expected. The performance
of a portal blood flow preserving procedure
is recommended.
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