Management of complications of portal XXXX .

@entity1 @entity1944 @entity101 @entity548 @entity75 @entity843 @entity254 @entity6118
The management of portal @entity101 focuses on control of its complications, the most important of which is @entity548 esophageal varices. Other complications, such as @entity843 , @entity548 @entity1944 , and @entity6118 , rarely require surgical intervention. Other than medical management, the three basic procedures now available for the treatment of @entity548 esophageal varices include decompression of varices with a portosystemic shunt, nonshunting operations that attack directly the esophageal variceal-bearing area, and liver transplantation as the procedure of choice in selected @entity1 . @entity1 who present with episodes of @entity548 are usually treated initially with medical therapy including acute sclerotherapy or balloon tamponade techniques when necessary. If the @entity1 fails to respond or if episodes of @entity548 recur, further therapy is required. Although selection of therapy remains controversial, it is based on multiple factors. These include the basic pathogenic mechanism of portal @entity101 in the individual @entity1 , status of the @entity1 as defined by @entity1 's classification, elective or urgent nature of the operation, hemodynamic stability of the @entity1 at the time of the procedure, site of the block in the portal system, and caliber and anatomic relationship of the vessels available for @entity254 in the portal system. Additional factors include the presence and severity of @entity843 or @entity75 , age of the @entity1 , site of @entity548 (esophageal or gastric), severity of associated @entity6118 , and techniques and expertise available at a given institution. Shunting procedures achieve the best long-term control of @entity548 , but they can precipitate the development of @entity75 . Nonshunting procedures do not induce @entity75 , but they are usually associated with a high rate of rebleeding. Also, with the possible exception of sclerotherapy, they are still associated with a high operative mortality rate in alcoholic @entity1 classified as @entity1 's C. Although sclerotherapy controls acute variceal @entity548 more successfully than conventional methods, it is not readily applicable in @entity1 with @entity548 gastric varices. Also, it has not yet clearly been proved to be an effective method of permanent control of @entity548 and has not been demonstrated to increase survival. The new methods of extensive esophagogastric devascularization (for example, porta-azygos disconnection using the Sugiura procedure) are attractive because of the low late recurrence rate for @entity548 without the induction of @entity75 .(ABSTRACT TRUNCATED AT 400 WORDS)
