Table of Contents
ISRN Gastroenterology
Volume 2013, Article ID 464053, 10 pages
http://dx.doi.org/10.1155/2013/464053
Review Article

The Surgical Treatment for Portal Hypertension: A Systematic Review and Meta-Analysis

Department of General Surgery, Second Hospital of Lanzhou University, 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu 730030, China

Received 28 November 2012; Accepted 28 December 2012

Academic Editors: K. D. Mullen and S. Odegaard

Copyright © 2013 Lanning Yin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Aim. To compare the effectiveness of surgical procedures (selective or nonselective shunt, devascularization, and combined shunt and devascularization) in preventing recurrent variceal bleeding and other complications in patients with portal hypertension. Methods. A systematic literature search of the Medline and Cochrane Library databases was carried out, and a meta-analysis was conducted according to the guidelines of the Quality of Reporting Meta-Analyses (QUOROM) statement. Results. There were a significantly higher reduction in rebleeding, yet a significantly more common encephalopathy ( ) in patients who underwent the shunt procedure compared with patients who had only a devascularization procedure. Further, there were no significant differences in rebleeding, late mortality, and encephalopathy between selective versus non-selective shunt. Next, the decrease of portal vein pressure, portal vein diameter, and free portal pressure in patients who underwent combined treatment with shunt and devascularization was more pronounced compared with patients who were treated with devascularization alone ( ). Conclusions. This meta-analysis shows clinical advantages of combined shunt and devascularization over devascularization in the prevention of recurrent variceal bleeding and other complications in patients with portal hypertension.