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
