Long-term results of portosystemic shunting in portal hypertension

The most serious complication of portal hypertension is bleeding from esophageal and gastric varices (EVV). In the Kyrgyz Republic, transplantation is in its infancy, there is no regulatory body in the country that controls transplant abroad, so patients independently travel outside the country for liver transplants. Due to the poor financial situation, the lethality in the process of waiting and accumulating funds reaches 95%. In our surgical practice at the Clinical Hospital of the UDP&P KR, we perform portosystemic shunting (PSB) in patients with intrahepatic and extrahepatic forms of PH. The aim of the work was to evaluate the long-term results of splenorenal venous bypass surgery in patients with liver cirrhosis. The main method was to study the results of interventions for the formation of portosystemic shunts at various times after the operation in a planned manner and according to the patient's appeal. An analysis of our own data on survival showed that the greatest number of deaths in patients with PH was noted in the first month after surgical treatment. The most common reason for this was complications arising in the postoperative period in the form of anastomotic thrombosis, which directly depends on the surgical technique for forming shunts. And the second main reason is the creation of anastomoses with a large window, when conditions arise for a greater partial discharge of blood into the systemic circulation, this is technically controlled when an anastomosis of adequate diameter is formed to maintain hepatopetal blood flow. In the subsequent periods of up to 1.5 years of follow-up, the survival rate was 74.1%, which, in our opinion, is due to the fact that the majority of patients - 79 (51.6%) before the PSS operation belonged to Child-Pugh A class, with less pronounced systemic complications in the body and, accordingly, with greater adaptive capabilities. Comparative lengthening of the life of these patients gives chances to get into the transplantation list.