La derivación portocava en la era del TIPS, la endoscopia y los trasplantes de hígado, su utilidad en la hemorragia esofágica aguda
Palabras clave:
hipertensión portal, várices esofágicas y gástricas, hemorragia gastrointestinal, derivación portocava quirúrgicaResumen
Las derivaciones portocava marcaron un hito en el devenir histórico de la cirugía para el manejo de la hipertensión portal. El sangrado por várices esofágicas representa una urgencia quirúrgica que demanda intervención inmediata. El tratamiento de las várices esofágicas por abordaje endoscópico o por TIPS y, por otra parte, el advenimiento del trasplante hepático como un procedimiento estándar, ha disminuido la frecuencia con que se realizan tales derivaciones. Sin embargo, estos procedimientos tienen indicaciones precisas, tanto como intervenciones de urgencia en algunos casos de hemorragia esofágica, como en forma electiva en determinados pacientes con hipertensión portal.
Hemos hecho una revisión de la literatura y de los conocimientos actuales de las derivaciones portocava a raíz de un caso tratado en forma exitosa en el Hospital Occidente de Kennedy en Bogotá, Colombia.
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Referencias bibliográficas
1. Lillegard JB, Hanna AM, McKenzie TJ, Moir CR, Ishitani MB, Nagorney DM. A single-institution review of portosystemic shunts in children: An ongoing discussion. HPB Surg. 2010; 2010: 964597.
https://doi.org/10.1155/2010/964597
2. Kato T, Romero R, Koutouby R, Mittal NK, Thompson JF, Schleien CL, et al. Portosystemic shunting in children during the era of endoscopic surgery. J Pediatric Gastroenterol Nutr. 2000;30:419-25.
https://doi.org/10.1097/00005176-200004000-00013
3. Wolff M, Hirner A. Current state of portosystemic shunt surgery. Langenbeck's Arch Surg. 2003;388:141-9.
https://doi.org/10.1007/s00423-003-0367-5
4. D'Amico G, Luca A. Natural history. Clinical-haemodynamic correlations. Prediction of the risk of bleeding. Baillieres Clin Gastroenterol. 1997;11:243-56.
https://doi.org/10.1016/S0950-3528(97)90038-5
6. de Franchis R, Primignani M. Natural history of portal hyperten- sion in patients with cirrhosis. Clin Liver Dis. 2001;5:645-63.
https://doi.org/10.1016/S1089-3261(05)70186-0
6. Rosch J, Keller FS. Transjugular intrahepatic portosystemic shunt: Present status, comparison with endoscopic therapy and shunt surgery, and future prospectives. World J Surg. 2001;25:337-46.
https://doi.org/10.1007/s002680020380
7. Banares R, Casado M, Rodríguez-Laiz JM, Camunez F, Matilla A, Echenagusia A, et al. Urgent transjugular intrahepatic por- tosystemic shunt for control of acute variceal bleeding. Am J Gastroenterol. 1998;93:75-9.
https://doi.org/10.1111/j.1572-0241.1998.075_c.x
8. Rikkers LF, Jin G. Surgical management of acute variceal he- morrhage. World J Surg. 1994;18:193-9.
https://doi.org/10.1007/BF00294400
9. Orloff MJ, Orloff MS, Rambotti M, Girard B. Is portal-systemic shunt worthwhile in Child's class C cirrhosis? Long-term results of emergency shunt in 94 patients with bleeding varices. Ann Surg. 1992;216:256-68.
https://doi.org/10.1097/00000658-199209000-00005
10. Orloff MJ, Bell RH Jr, Orloff MS, Hardison WG, Greenburg AG. Prospective randomized trial of emergency portacaval shunt and emergency medical therapy in unselected cirrhotic patients with bleeding varices. Hepatology. 1994;20:863-72.
https://doi.org/10.1002/hep.1840200414
11. Warren WD. Presidential address: Reflections on the early development of portacaval shunts. Ann Surg. 1980;191:519-27.
https://doi.org/10.1097/00000658-198005000-00001
12. Grinnell RS. Omentopexy in portal cirrhosis of the liver with ascites: A review of twenty-three cases. Ann Surg. 1935;101:891-901.
https://doi.org/10.1097/00000658-193503000-00009
13. Ellis DS, Jones CM, Linton RR. The effect of venous shunt surgery on liver function in patients with portal hypertension; a follow-up study of 125 patients operated upon in the last ten years. Trans Am Clin Climatol Assoc. 1955;67:198-212.
14. Rypins EB, Milne N, Sarfeh IJ. Analysis of nutrient hepatic blood flow after 8-mm versus 16-mm portacaval H-grafts in a prospective randomized trial. Am J Surg. 1995;169:197-201.
https://doi.org/10.1016/S0002-9610(99)80136-6
15. Millikan WJ, Jr., Warren WD, Henderson JM, Smith RB, 3rd, Salam AA, Galambos JT, et al. The Emory prospective randomi- zed trial: selective versus nonselective shunt to control variceal bleeding. Ten year follow-up. Ann Surg. 1985;201:712-22.
https://doi.org/10.1097/00000658-198506000-00007
16. Rypins EB, Mason GR, Conroy RM, Sarfeh IJ. Predictability and maintenance of portal flow patterns after small-diameter portacaval H-grafts in man. Ann Surg. 1984;200:706-10.
https://doi.org/10.1097/00000658-198412000-00006
17. Rikkers LF, Jin G, Langnas AN, Shaw BW Jr. Shunt surgery during the era of liver transplantation. Ann Surg. 1997;226:51-7.
https://doi.org/10.1097/00000658-199707000-00007
18. Jenkins RL, Gedaly R, Pomposelli JJ, Pomfret EA, Gordon F, Lewis WD. Distal splenorenal shunt: Role, indications, and utility in the era of liver transplantation. Arch Surg. 1999;134:416-20.
https://doi.org/10.1001/archsurg.134.4.416
19. Orozco H, Mercado MA. The evolution of portal hypertension surgery: Lessons from 1,000 operations and 50 years' experience. Arch Surg. 2000;135:1389-94.
https://doi.org/10.1001/archsurg.135.12.1389
20. Henderson JM, Nagle A, Curtas S, Geisinger M, Barnes D. Sur- gical shunts and TIPS for variceal decompression in the 1990s. Surgery. 2000;128:540-7.
https://doi.org/10.1067/msy.2000.108209
21. Collins JC, Ong MJ, Rypins EB, Sarfeh IJ. Partial portacaval shunt for variceal hemorrhage: Longitudinal analysis of effec- tiveness. Arch Surg. 1998;133:590-4.
https://doi.org/10.1001/archsurg.133.6.590
22. Rosemurgy AS, Serafini FM, Zweibel BR, Black TJ, Kudryk BT, Nord HJ, et al. Transjugular intrahepatic portosystemic shunt Vs. small-diameter prosthetic H-graft portacaval shunt: Extended follow-up of an expanded randomized prospective trial. J Gastrointest Surg. 2000;4:589-97.
https://doi.org/10.1016/S1091-255X(00)80107-9
23. Rosemurgy AS, Molloy DL, Thometz DP, Villadolid DV, Cow- gill SM, Zervos EE. TIPS in Florida: Is its application a result of evidence-based medicine? J Am Coll Surg. 2007;204:794-802.
https://doi.org/10.1016/j.jamcollsurg.2007.01.014
24. Ripamonti R, Ferral H, Alonzo M, Patel NH. Transjugular intra- hepatic portosystemic shunt-related complications and practical solutions. Semin Intervent Radiol. 2006;23:165-76.
https://doi.org/10.1055/s-2006-941447
25. Rosemurgy AS, Zervos EE, Bloomston M, Durkin AJ, Clark WC, Goff S. Post-shunt resource consumption favors small- diameter prosthetic H-graft portacaval shunt over TIPS for patients with poor hepatic reserve. Ann Surg. 2003;237:820-7.
https://doi.org/10.1097/01.SLA.0000072102.38993.05
26. Punamiya SJ, Amarapurkar DN. Role of TIPS in Improving survival of patients with decompensated liver disease. Int J Hepatol. 2011;2011:398291. Epub 2011 Jul 2.
https://doi.org/10.4061/2011/398291
27. Rossle M. When endoscopic therapy or pharmacotherapy fails to control variceal bleeding: what should be done? Imme- diate control of bleeding by TIPS? Langenbecks Arch Surg. 2003;388:155-62.
https://doi.org/10.1007/s00423-003-0372-8
28. Lopera JE. Role of emergency transjugular intrahepatic por- tosystemic shunts. Semin Intervent Radiol. 2005;22:253-65.
https://doi.org/10.1055/s-2005-925551
29. Bosch J, Berzigotti A, García-Pagan JC, Abraldes JG. The management of portal hypertension: Rational basis, available treatments and future options. J Hepatol. 2008;48(Suppl.1):S68-92.
https://doi.org/10.1016/j.jhep.2008.01.021
30. Cadavid AJ, Santacoloma M, González RA. Estudio comparativo entre dos métodos de tratamiento del sangrado digestivo alto de tipo varicoso. Rev Colomb Gastroenterol. 2000;15:161-4.
31. Chau TN, Patch D, Chan YW, Nagral A, Dick R, Burroughs AK. "Salvage" transjugular intrahepatic portosystemic shunts: Gastric fundal compared with esophageal variceal bleeding. Gastroenterology. 1998;114:981-7.
https://doi.org/10.1016/S0016-5085(98)00640-4
32. Johnson M, Rajendran S, Balachandar TG, Kannan D, Jeswanth S, Ravichandran P, et al. Transabdominal modified devasculari- zation procedure with or without esophageal stapler transection -an operation adequate for effective control of a variceal bleed. Is esophageal stapler transection necessary? World J Surg. 2006;30:1507-19.
https://doi.org/10.1007/s00268-005-0754-x
33. Dagenais M, Langer B, Taylor BR, Greig PD. Experience with ra- dical esophagogastric devascularization procedures (Sugiura) for variceal bleeding outside Japan. World J Surg. 1994;18:222-8.
https://doi.org/10.1007/BF00294405
34. Selzner M, Tuttle-Newhall JE, Dahm F, Suhocki P, Clavien PA. Current indication of a modified Sugiura procedure in the mana- gement of variceal bleeding. J Am Coll Surg. 2001;193:166-73.
https://doi.org/10.1016/S1072-7515(01)00937-1
35. Borgonovo G, Costantini M, Grange D, Vons C, Smadja C, Fran- co D. Comparison of a modified Sugiura procedure with portal systemic shunt for prevention of recurrent variceal bleeding in cirrhosis. Surgery. 1996;119:214-21.
https://doi.org/10.1016/S0039-6060(96)80172-3
36. Romero-Torres R. Hemostatic suture of the stomach for the treatment of massive hemorrhage due to esophageal varices. Surg Gynecol Obstet. 1981;153:710-2.
37. Romero-Torres R. A new surgical approach for the treatment of massive hemorrhage due to esophageal varices. J Cardiovasc Surg (Torino). 1981;22:555-60.
38. Romero-Torres R. Long-term results of hemostatic gastric su- ture in the treatment of esophagogastric varices. World J Surg. 1989;13:313-6.
https://doi.org/10.1007/BF01659042
39. Clark W, Hernández J, McKeon B, Villadolid D, Al-Saadi S, Mullinax J, et al. Surgical shunting versus transjugular intrahe- patic portasystemic shunting for bleeding varices resulting from portal hypertension and cirrhosis: A meta-analysis. Am Surg. 2010;76:857-64.
40. Costa G, Cruz RJ Jr, Abu-Elmagd KM. Surgical shunt versus TIPS for treatment of variceal hemorrhage in the current era of liver and multivisceral transplantation. Surg Clin North Am. 2010;90:891-905.
https://doi.org/10.1016/j.suc.2010.04.015
41. Aydin U, Yazici P, Kilic M. Porto-systemic shunt using adrenal vein as a conduit; an alternative procedure for spleno--renal shunt. BMC Surg. 2007;7:7.
https://doi.org/10.1186/1471-2482-7-7
42. Abou Jaoude MM, Almawi WY. Liver transplantation in patients with previous portasystemic shunt. Transplant Proc. 2001;33:2723-5.
https://doi.org/10.1016/S0041-1345(01)02161-3
https://doi.org/10.1155/2010/964597
2. Kato T, Romero R, Koutouby R, Mittal NK, Thompson JF, Schleien CL, et al. Portosystemic shunting in children during the era of endoscopic surgery. J Pediatric Gastroenterol Nutr. 2000;30:419-25.
https://doi.org/10.1097/00005176-200004000-00013
3. Wolff M, Hirner A. Current state of portosystemic shunt surgery. Langenbeck's Arch Surg. 2003;388:141-9.
https://doi.org/10.1007/s00423-003-0367-5
4. D'Amico G, Luca A. Natural history. Clinical-haemodynamic correlations. Prediction of the risk of bleeding. Baillieres Clin Gastroenterol. 1997;11:243-56.
https://doi.org/10.1016/S0950-3528(97)90038-5
6. de Franchis R, Primignani M. Natural history of portal hyperten- sion in patients with cirrhosis. Clin Liver Dis. 2001;5:645-63.
https://doi.org/10.1016/S1089-3261(05)70186-0
6. Rosch J, Keller FS. Transjugular intrahepatic portosystemic shunt: Present status, comparison with endoscopic therapy and shunt surgery, and future prospectives. World J Surg. 2001;25:337-46.
https://doi.org/10.1007/s002680020380
7. Banares R, Casado M, Rodríguez-Laiz JM, Camunez F, Matilla A, Echenagusia A, et al. Urgent transjugular intrahepatic por- tosystemic shunt for control of acute variceal bleeding. Am J Gastroenterol. 1998;93:75-9.
https://doi.org/10.1111/j.1572-0241.1998.075_c.x
8. Rikkers LF, Jin G. Surgical management of acute variceal he- morrhage. World J Surg. 1994;18:193-9.
https://doi.org/10.1007/BF00294400
9. Orloff MJ, Orloff MS, Rambotti M, Girard B. Is portal-systemic shunt worthwhile in Child's class C cirrhosis? Long-term results of emergency shunt in 94 patients with bleeding varices. Ann Surg. 1992;216:256-68.
https://doi.org/10.1097/00000658-199209000-00005
10. Orloff MJ, Bell RH Jr, Orloff MS, Hardison WG, Greenburg AG. Prospective randomized trial of emergency portacaval shunt and emergency medical therapy in unselected cirrhotic patients with bleeding varices. Hepatology. 1994;20:863-72.
https://doi.org/10.1002/hep.1840200414
11. Warren WD. Presidential address: Reflections on the early development of portacaval shunts. Ann Surg. 1980;191:519-27.
https://doi.org/10.1097/00000658-198005000-00001
12. Grinnell RS. Omentopexy in portal cirrhosis of the liver with ascites: A review of twenty-three cases. Ann Surg. 1935;101:891-901.
https://doi.org/10.1097/00000658-193503000-00009
13. Ellis DS, Jones CM, Linton RR. The effect of venous shunt surgery on liver function in patients with portal hypertension; a follow-up study of 125 patients operated upon in the last ten years. Trans Am Clin Climatol Assoc. 1955;67:198-212.
14. Rypins EB, Milne N, Sarfeh IJ. Analysis of nutrient hepatic blood flow after 8-mm versus 16-mm portacaval H-grafts in a prospective randomized trial. Am J Surg. 1995;169:197-201.
https://doi.org/10.1016/S0002-9610(99)80136-6
15. Millikan WJ, Jr., Warren WD, Henderson JM, Smith RB, 3rd, Salam AA, Galambos JT, et al. The Emory prospective randomi- zed trial: selective versus nonselective shunt to control variceal bleeding. Ten year follow-up. Ann Surg. 1985;201:712-22.
https://doi.org/10.1097/00000658-198506000-00007
16. Rypins EB, Mason GR, Conroy RM, Sarfeh IJ. Predictability and maintenance of portal flow patterns after small-diameter portacaval H-grafts in man. Ann Surg. 1984;200:706-10.
https://doi.org/10.1097/00000658-198412000-00006
17. Rikkers LF, Jin G, Langnas AN, Shaw BW Jr. Shunt surgery during the era of liver transplantation. Ann Surg. 1997;226:51-7.
https://doi.org/10.1097/00000658-199707000-00007
18. Jenkins RL, Gedaly R, Pomposelli JJ, Pomfret EA, Gordon F, Lewis WD. Distal splenorenal shunt: Role, indications, and utility in the era of liver transplantation. Arch Surg. 1999;134:416-20.
https://doi.org/10.1001/archsurg.134.4.416
19. Orozco H, Mercado MA. The evolution of portal hypertension surgery: Lessons from 1,000 operations and 50 years' experience. Arch Surg. 2000;135:1389-94.
https://doi.org/10.1001/archsurg.135.12.1389
20. Henderson JM, Nagle A, Curtas S, Geisinger M, Barnes D. Sur- gical shunts and TIPS for variceal decompression in the 1990s. Surgery. 2000;128:540-7.
https://doi.org/10.1067/msy.2000.108209
21. Collins JC, Ong MJ, Rypins EB, Sarfeh IJ. Partial portacaval shunt for variceal hemorrhage: Longitudinal analysis of effec- tiveness. Arch Surg. 1998;133:590-4.
https://doi.org/10.1001/archsurg.133.6.590
22. Rosemurgy AS, Serafini FM, Zweibel BR, Black TJ, Kudryk BT, Nord HJ, et al. Transjugular intrahepatic portosystemic shunt Vs. small-diameter prosthetic H-graft portacaval shunt: Extended follow-up of an expanded randomized prospective trial. J Gastrointest Surg. 2000;4:589-97.
https://doi.org/10.1016/S1091-255X(00)80107-9
23. Rosemurgy AS, Molloy DL, Thometz DP, Villadolid DV, Cow- gill SM, Zervos EE. TIPS in Florida: Is its application a result of evidence-based medicine? J Am Coll Surg. 2007;204:794-802.
https://doi.org/10.1016/j.jamcollsurg.2007.01.014
24. Ripamonti R, Ferral H, Alonzo M, Patel NH. Transjugular intra- hepatic portosystemic shunt-related complications and practical solutions. Semin Intervent Radiol. 2006;23:165-76.
https://doi.org/10.1055/s-2006-941447
25. Rosemurgy AS, Zervos EE, Bloomston M, Durkin AJ, Clark WC, Goff S. Post-shunt resource consumption favors small- diameter prosthetic H-graft portacaval shunt over TIPS for patients with poor hepatic reserve. Ann Surg. 2003;237:820-7.
https://doi.org/10.1097/01.SLA.0000072102.38993.05
26. Punamiya SJ, Amarapurkar DN. Role of TIPS in Improving survival of patients with decompensated liver disease. Int J Hepatol. 2011;2011:398291. Epub 2011 Jul 2.
https://doi.org/10.4061/2011/398291
27. Rossle M. When endoscopic therapy or pharmacotherapy fails to control variceal bleeding: what should be done? Imme- diate control of bleeding by TIPS? Langenbecks Arch Surg. 2003;388:155-62.
https://doi.org/10.1007/s00423-003-0372-8
28. Lopera JE. Role of emergency transjugular intrahepatic por- tosystemic shunts. Semin Intervent Radiol. 2005;22:253-65.
https://doi.org/10.1055/s-2005-925551
29. Bosch J, Berzigotti A, García-Pagan JC, Abraldes JG. The management of portal hypertension: Rational basis, available treatments and future options. J Hepatol. 2008;48(Suppl.1):S68-92.
https://doi.org/10.1016/j.jhep.2008.01.021
30. Cadavid AJ, Santacoloma M, González RA. Estudio comparativo entre dos métodos de tratamiento del sangrado digestivo alto de tipo varicoso. Rev Colomb Gastroenterol. 2000;15:161-4.
31. Chau TN, Patch D, Chan YW, Nagral A, Dick R, Burroughs AK. "Salvage" transjugular intrahepatic portosystemic shunts: Gastric fundal compared with esophageal variceal bleeding. Gastroenterology. 1998;114:981-7.
https://doi.org/10.1016/S0016-5085(98)00640-4
32. Johnson M, Rajendran S, Balachandar TG, Kannan D, Jeswanth S, Ravichandran P, et al. Transabdominal modified devasculari- zation procedure with or without esophageal stapler transection -an operation adequate for effective control of a variceal bleed. Is esophageal stapler transection necessary? World J Surg. 2006;30:1507-19.
https://doi.org/10.1007/s00268-005-0754-x
33. Dagenais M, Langer B, Taylor BR, Greig PD. Experience with ra- dical esophagogastric devascularization procedures (Sugiura) for variceal bleeding outside Japan. World J Surg. 1994;18:222-8.
https://doi.org/10.1007/BF00294405
34. Selzner M, Tuttle-Newhall JE, Dahm F, Suhocki P, Clavien PA. Current indication of a modified Sugiura procedure in the mana- gement of variceal bleeding. J Am Coll Surg. 2001;193:166-73.
https://doi.org/10.1016/S1072-7515(01)00937-1
35. Borgonovo G, Costantini M, Grange D, Vons C, Smadja C, Fran- co D. Comparison of a modified Sugiura procedure with portal systemic shunt for prevention of recurrent variceal bleeding in cirrhosis. Surgery. 1996;119:214-21.
https://doi.org/10.1016/S0039-6060(96)80172-3
36. Romero-Torres R. Hemostatic suture of the stomach for the treatment of massive hemorrhage due to esophageal varices. Surg Gynecol Obstet. 1981;153:710-2.
37. Romero-Torres R. A new surgical approach for the treatment of massive hemorrhage due to esophageal varices. J Cardiovasc Surg (Torino). 1981;22:555-60.
38. Romero-Torres R. Long-term results of hemostatic gastric su- ture in the treatment of esophagogastric varices. World J Surg. 1989;13:313-6.
https://doi.org/10.1007/BF01659042
39. Clark W, Hernández J, McKeon B, Villadolid D, Al-Saadi S, Mullinax J, et al. Surgical shunting versus transjugular intrahe- patic portasystemic shunting for bleeding varices resulting from portal hypertension and cirrhosis: A meta-analysis. Am Surg. 2010;76:857-64.
40. Costa G, Cruz RJ Jr, Abu-Elmagd KM. Surgical shunt versus TIPS for treatment of variceal hemorrhage in the current era of liver and multivisceral transplantation. Surg Clin North Am. 2010;90:891-905.
https://doi.org/10.1016/j.suc.2010.04.015
41. Aydin U, Yazici P, Kilic M. Porto-systemic shunt using adrenal vein as a conduit; an alternative procedure for spleno--renal shunt. BMC Surg. 2007;7:7.
https://doi.org/10.1186/1471-2482-7-7
42. Abou Jaoude MM, Almawi WY. Liver transplantation in patients with previous portasystemic shunt. Transplant Proc. 2001;33:2723-5.
https://doi.org/10.1016/S0041-1345(01)02161-3
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2011-07-01
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Nieves, E.; Ramírez, M. La derivación Portocava En La Era Del TIPS, La Endoscopia Y Los Trasplantes De hígado, Su Utilidad En La Hemorragia esofágica Aguda. Rev Colomb Cir 2011, 26, 207-213.
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