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Surgical Treatment: Selective Shunt Surgery

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Clinical Investigation of Portal Hypertension

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Abstract

A number of surgical procedures have been developed for the management of esophagogastric varices. They can be broadry classified into shunting and nonshunting procedures. There are two types of shunting procedure, namely nonselective and selective. Nonselective shunts, such as portacaval or mesocaval shunts, effectively reduce the incidence of variceal bleeding, but they carry a high risk of postoperative encephalopathy as a result of hyperammonemia. Selective shunts such as the distal splenorenal shunt (DSRS) or left gastric venous caval shunt were developed to preserve portal blood flow through the liver and reduce esophagogastric variceal pressure. The DSRS effectively prevents rebleeding, but it still carries a risk of postoperative encephalopathy. In order to prevent both postoperative encephalopathy and bleeding, we have improved the DSRS procedure by additionally performing splenopancreatic disconnection and gastric transection.

In conclusion, endoscopic treatments have been developed recently and are performed widely performed for esophagogastric varices; however, surgery in the form of DSRS is also useful for managing esophagogastric varices in patients with idiopathic portal hypertension in the absence of severe liver pathologies.

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Authors and Affiliations

  1. Department of Surgery, Nippon Medical School, Tokyo, Japan

    Hiroshi Yoshida, Yasuhiro Mamada & Eiji Uchida

  2. Department of Surgery, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan

    Hiroshi Makino, Tadashi Yokoyama, Hiroshi Maruyama, Atsushi Hirakata, Junji Ueda & Hideyuki Takata

  3. Department of Surgery, Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan

    Nobuhiko Taniai

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  1. Hiroshi Yoshida
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  2. Hiroshi Makino
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  3. Tadashi Yokoyama
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  4. Hiroshi Maruyama
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  5. Atsushi Hirakata
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  6. Junji Ueda
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  7. Hideyuki Takata
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  8. Yasuhiro Mamada
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  9. Nobuhiko Taniai
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  10. Eiji Uchida
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Correspondence to Hiroshi Yoshida .

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Editors and Affiliations

  1. Department of Advanced Gastrointestinal Endoscopy, Fukushima Medical University, Fukushima, Japan

    Katsutoshi Obara

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Yoshida, H. et al. (2019). Surgical Treatment: Selective Shunt Surgery. In: Obara, K. (eds) Clinical Investigation of Portal Hypertension. Springer, Singapore. https://doi.org/10.1007/978-981-10-7425-7_44

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  • DOI: https://doi.org/10.1007/978-981-10-7425-7_44

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-7424-0

  • Online ISBN: 978-981-10-7425-7

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