Evolution of approaches to portal hypertension syndrome and principles underlying treatment personalization

Abstract

Aim. To analyze various strategies aimed at mitigating complications of the portal hypertension syndrome at the Minsk Scientific and Practical Center for Surgery, Transplantology, and Hematology.Material and methods. Patients who had undergone different types of treatment were retrospectively observed: shunt surgery to form portacaval anastomoses, transjugular portosystemic shunt placement, and liver transplantation. The following parameters were analyzed: incidence of complications, hospital mortality rate, survival rate, and perioperative indicators.Results. Since 1980, 131 shunt surgeries have been performed at the Center, while 880 liver transplantations and 232 transjugular portosystemic shunt placement procedures have been performed since 2008. Among 68 patients with compensated cirrhosis who had undergone shunt placement, no hospital mortality rate was reported, whereas in patients with Child-Pugh B cirrhosis and Child–Pugh C cirrhosis, it reached 19.5% and 87.5%, respectively. Following TIPS, the overall case mortality rate amounted to 9.9% (following TIPS prior to transplantation – 8.2%, following TIPS used as the final treatment – 12.8%). After liver transplantation, in-hospital mortality rate reached 7.7%.Conclusion. Over 50 years, the strategy for managing portal hypertension has undergone significant changes due to the establishment of institutions providing a complete cycle of all treatment measures for such patients. Patients suffering from the complications of the portal hypertension syndrome tend to receive the most effective treatment in hospitals having experience in rational conservative therapy, endovascular procedures, and transplantation.