[Surgical treatment of portal hypertension: the state of art].

The article highlights modern approaches to the treatment of portal hypertension. The differential tactics is based on the type of portal hypertension, functional liver state, urgency of the situation and severity of blood loss, localization and stage of varices, concomitant diseases, etc. The role of miniinvasive methods is stressed.

[Combined operations for prophylaxis of gastroesophageal bleedings at the patients with portal hypertension].

Results of portocaval bypass (1st group), suture ligation of gastric and esophageal varicose veins (2nd group), and combined operations (3rd group) performed in early postoperative period at 759 patients with liver cirrhosis and extrahepatic portal hypertension are analyzed. Long-term results were studied at 549 patients. Early recurrence of bleeding was occurred at 41 (12.

[Late results of portacaval surgical shunt in patients with extrahepatic portal hypertension].

Late outcomes of portocaval shunting (PCS) were analyzed in 135 patients with extrahepatic portal hypertension (EPH). It was established that the methods of choice in such patients should be splenorenal anastomosis, mesentericocaval anastomosis (MCA) "side by side" and H-type with autovenous or synthetic insertions. The best results were detected in a combination of portocaval anastomosis with the suturing pf stomach and esophageal varicose veins, if the diameter of the anastomosed vessel was small and portal pressure was reduced by less than 25% (100 mm of water column).

[Surgical treatment of resistant ascites in patients with portal hypertension].

Surgical methods of treatment of diureticoresistant ascites in 198 patients with portal hypertension are analyzed: portocaval bypass (n = 16), lymphovenous anastomosis (n = 64), ductolysis (n = 24), and peritoneovenous bypass (n = 94). The most stable positive results was achieved after portocaval bypass, but it can be performed only in a small part of patients. Peritoneovenous bypass and lymphovenous anastomosis demonstrated shorter effect but they had less risk and were better tolerated than portocaval bypass.

[The evolution of surgery for extrahepatic portal hypertension].

30 years' experience of elective surgical treatment of 600 patients with extrahepatic portal hypertension is summarized. Insufficient effectiveness of splenectomy in bleeding from varicose veins (VV) of the stomach and the esophagus (40% of relapses) is shown as well as frequent development (25%) of asplenic hemorrhagic thrombocytopenia. Partial esophagogastrectomy also has failed initial hopes due to severe agastric anemia which developed in 49.

[Orthotopic liver transplantation (first clinical experience)].

The article deals with the results of work conducted according to the orthotopic liver transplantation (OLT) program from January 1990 to January 1992. To select the patients for OLT, 54 persons (24 males and 30 females aged from 12 to 55 years) with diffuse (34) and focal (20) diseases of the liver were examined. OLT was indicated for 19 patients who were registered in the waiting list.

[X-ray intravascular reduction of blood flow along the hepatic artery in patients with portal hypertension and resistant ascites].

After studying the results of embolization of the hepatic artery in 14 patients with portal hypertension and resistant ascites the authors came to the conclusion that this operation often leads to the development of hepatic insufficiency and a fatal outcome and produces a clinical effect only in a small number of patients. Celiac- and mesenteric angiography and transhepatic portography were carried out for pathogenetic substantiation of the intervention. Pressure in the portal vein, hepatic veins and arteries, and in the inferior vena cava was measured during the examination.

[Study of central and porto-hepatic hemodynamics before the surgical treatment of patients with liver cirrhosis and portal hypertension].

Basing on the results of hemodynamic findings related to the heart and liver in 41 patients with hepatic cirrhosis and portal hypertension (33 of them were operated on for portal hypertension), it is suggested that when deciding on the type of surgery in such patients, initial status of central and portal hemodynamics as well as expected changes in these parameters due to surgery should be taken into consideration. Pathogenetic grounds for some routine interventions in hepatic cirrhosis and portal hypertension are thought open to question.

[Peritoneovenous shunt in resistant ascites in patients with portal hypertension].

Experience in 100 operations for the creation of a peritoneovenous shunt in 63 patients with portal hypertension and resistant ascites showed that in careful selection of patients and determination of contraindications this operation is an effective method for the treatment of resistant ascites in patients with portal hypertension. The shunt increases diuresis, reduces the volume of the abdomen, makes laparocentesis unnecessary, improves the patients' general condition and allows some of them to be prepared for interventions on the organs of the portal system which are more radical in character.

[Surgical treatment of segmental extrahepatic portal hypertension].

The authors analyse the immediate and late-term results of surgical treatment of 39 patients who underwent 50 operations for segmental extrahepatic portal hypertension (SEPH). The threat of gastric hemorrhage was the main indication for surgery. Gastrotomy with suturing of the varicose veins of the stomach is the operation of choice when gastric hemorrhage continues.

[Controlled drainage of the thoracic duct (author's transl)].

The technique of the thoracic duct drainage is described. The importance of preserving the natural lymph outflow is emphasized. A method of controlled thoracic duct drainage is introduced that permits dosaged exteriorization of the lymph and additional internal drainage of the lymph into the veins via an external bypass for a long period of time.