Es importante resaltar que el manejo derivativo quirúrgico es una opción valida, vigente y que cobra fuerza. Ante la evidencia disponible, el tipo de derivación debería escogerse a la luz del pronóstico, variaciones anatómicas y experiencias quirúrgicas 41; pueden salvar la vida del paciente y no contraindica posteriormente un trasplante hepático 42.
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La decisión de llevar a cirugía depende de la respuesta al manejo médico y endoscópico instaurado 29, pero en caso de fallar, contemporizar su manejo de forma “expectante” usualmente conllevan a un deterioro clínico, hemodinámico, empeoramiento de su clasificación de Child, que influye directamente en morbilidad y mortalidad, por lo cual diferir este procedimiento disminuye la posibilidad de un desenlace favorable.
Portocaval Shunts in the Era of TIPS, Endoscopy and Liver Transplantation. Indications in Acute Esophageal Hemorrhage
Abstract
Portocaval shunts constitute a milestone in the history of the surgical treatment of portal hypertension. Bleeding from esophageal varices is a surgical emergency that demands immediate intervention. The endoscopic management of esophageal varices and the advent of TIPS, plus the development of liver transplantation have diminished the frequency of the use of portocaval shunts. However, these procedures have precise indications, both as emergency operations in some cases of esophageal varicose hemorrhage as well as elective procedures in selected patients with portal hypertension.
We hereby present a literature review of the “state of the art” of portocaval shunts motivated by a patient that was successfully treated at Hospital Occidente de Kennedy in Bogotá, Colombia.
Key words: portal hypertension; esophageal and gastric varices; gastyroiestinal hemorrhage; surgical portocaval Shunt
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Correspondencia: ERNESTO NIEVES, MD
Correo electrónico: ernestonieves1@me.com
Bogotá, Colombia
