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Reoperations for Bleeding Portal Hypertension. Surgical Rescue of Surgical Failures

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      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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      [ ] Portal Hypertension Clinic Instituto Nacional de la Nutrición Salvador Zubirán Vasco de Quiroga 15 México, D.F. Tlalpan 14000 Mexico
      HPB Surg
      HPB Surgery
      Hindawi Publishing Corporation
      April 1999
      : 11
      : 3
      : 151-155
      Copyright © 1999 Hindawi Publishing Corporation.

      This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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