Current status and perspectives of surgical treatment of portal hypertension

The surgical treatment of portal hypertension once guided the development of modern surgery. In the past 10- 20 years,the non-surgical therapies including drugs to screen and control esophagogastric variceal bleeding,endoscopic variceal ligation,and transjugular intrahepatic portosystemic shunt have been widely applied in clinical practice. Surgical treatment is only applicable to those patients who do not respond to endoscopic treatment and have Child- Pugh class A liver function. At present,the following three surgeries have been universally acknowledged: distal splenorenal shunt,extensive pericardial devascularization combined with splenectomy,and two- stage transthoracic transabdominal combined devascularization. Due to a lack of liver donors in China,liver transplantation cannot be widely applied. Laparoscopic splenectomy and laparoscopic splenectomy combined with pericardial devascularization are great challenges for patients with cirrhotic portal hypertension. The author thinks that the surgical treatment of portal hypertension should collaborate with non- surgical therapies to develop individualized treatment regimens for patients with liver cirrhosis and non- cirrhotic portal hypertension.