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Digestive Disease Interventions 2020; 04(02): 157-167
DOI: 10.1055/s-0040-1713371
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Surgical Portosystemic Shunts: History, Evolution, and Current Applications

Fidel Lopez-Verdugo 
1   Department of Hepatobiliary and Transplant Surgery, Intermountain Medical Center, Pediatric Liver Transplant Service, Primary Children's Hospital, Salt Lake City, Utah
,
Jorge Sánchez-García 
2   Department of Hepatobiliary Surgery, Transplant Services, Intermountain Medical Center, Salt Lake City, Utah
,
Andrew Gagnon
2   Department of Hepatobiliary Surgery, Transplant Services, Intermountain Medical Center, Salt Lake City, Utah
,
Zachary J. Kastenberg
3   Division of Pediatric Surgery, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah
,
Ivan Zendejas
2   Department of Hepatobiliary Surgery, Transplant Services, Intermountain Medical Center, Salt Lake City, Utah
,
G. Peter Feola
4   Division of Pediatric Interventional Radiology, Primary Children's Hospital, Salt Lake City, Utah
,
Manuel I. Rodriguez-Davalos 
5   Pediatric Liver Transplant Service, Intermountain Primary Children's Hospital, Salt Lake City, Utah
6   Department of Hepatobiliary and Transplant Surgery, Intermountain Medical Center, Murray, Utah
› Author Affiliations
Further Information

Publication History

20 February 2020

28 April 2020

Publication Date:
03 July 2020 (online)

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Abstract

Mechanical obstruction, thrombus, intrinsic liver disease causing fibrosis or cirrhosis, or an outflow obstruction at the level of the sinusoids or hepatic venous obstruction can cause an increase in pressure or resistance, or both, leading to portal hypertension (PH). Portosystemic shunts (PSS) are usually performed to relieve the congestion that inevitably occurs in the setting of PH. Since their introduction, surgical PSS were often the treatment of choice to prevent recurrent bleeding in patients with clinically significant PH. Development of novel pharmacological therapies, continuous improvement of endoscopic approaches, the introduction of transjugular intrahepatic portosystemic shunt, and advancements in transplantation has provided an evolution in the approach for PH and has precipitated the steady decrease in the proportion of patients needing surgical shunts. Despite this, PSS remain important tools in the surgeon's armamentarium, as they are often employed in the pediatric population with extrahepatic portal vein obstruction and are frequently being used for portal inflow modulation to achieve better portal hemodynamics in resections and transplantation. This has become of great relevance to decrease the risk of small-for-size syndrome and portal hyperperfusion in liver transplantation, and to decrease the risk of posthepatectomy liver dysfunction after major resections in hepatobiliary surgery.

Keywords

surgical portosystemic shunts - living donor liver transplantation - meso-Rex bypass