CLINICAL, ENDOIMAGISTIC AND MORFOLOGIC PROFILE OF PACIENTS WITH PORTAL HYPERTENSION DUE TO CIRRHOSIS AND THERAPEUTIC OPTIONS

Abstract

Objectives. Portal hypertension plays a major role among causes of death due to hepatic cirrhosis and it has a variable clinical presentation and a difficult multimodal therapeutic management.

Material and method. We conducted a retrospective study within the Surgery Department No 1, USMF “Nicolae Testemițanu”, over the 2010-2020 period, which included cirrhotic patients diagnosed and surgically treated for portal hypertension.

Results. The study included 366 patients. The male/female ratio was 149/217, and the average age of 46±5.27 years. Child score of those included in the study was A/B/C = 27/314/25. The diagnosis was confirmed by a combination of clinical, biochemical, imagistic, surgical and morphopathological investigations (Knodell-Desmet/Fibroscan). The order of surgical interventions by frequency was: Hassab azygoportal devascularization (open approach – 302, laparoscopic approach – 42 cases); liver transplantation – 14 cases and porto-cave anastamosis – 8 cases. Also, in association with first interventions, we performed 16 cholecystectomies, 10 appendicectomies, 2 pancreatic caudal resections and a gastric resection.

Conclusion. The selection of patients with hepatic cirrhosis and portal hypertension PH of surgical interest is rigorous and requires an interdisciplinary consensus, where the severity of changes in the portal hemodynamics has a decisive value in adapting a selective management and in obtaining successful therapeutic results.