Hepatic encephalopathy after portosystemic bypass surgery

• Published in: Hirurgija (Moskva) no. 7; p. 57
• Main Authors: Margaryan, S R, Mitupov, Z B, Razumovsky, A Yu
• Format: Journal Article
• Language: Russian
• Published: Russia (Federation) 2023
• Subjects: Child; Gastrointestinal Hemorrhage - surgery; Hepatic Encephalopathy - diagnosis; Hepatic Encephalopathy - etiology; Humans; Hypertension, Portal - diagnosis; Hypertension, Portal - etiology; Hypertension, Portal - surgery; Portasystemic Shunt, Transjugular Intrahepatic; Treatment Outcome; hyperammonemia; liver failure; total portosystemic shunt; portal hypertension; children; hepatic encephalopathy
• ISSN: 0023-1207
• DOI: 10.17116/hirurgia202307157

The most effective modern treatment for gastrointestinal bleeding following portal hypertension is portosystemic bypass surgery. Hepatic encephalopathy after these procedures is still an urgent problem in modern pediatric surgery, and radical treatment is unknown. To optimize treatment outcomes in children with hepatic encephalopathy, we should choose adequate treatment considering the risk of hepatic encephalopathy in the future. In this review, the authors discuss modern data on hepatic encephalopathy regarding symptoms, advantages and disadvantages of various treatment methods. Risk of hepatic encephalopathy with and without surgical treatment, as well as methods of diagnosis and treatment are particularly analyzed. Total portosystemic bypass surgery, especially portocaval shunt, is followed by higher risk of hepatic encephalopathy compared to selective shunts and physiological mesoportal bypass. The last two approaches are advisable to improve treatment outcomes in children with hepatic encephalopathy.