A modified incision for upper abdominal surgery in portal hypertension patients: could it avoid portal vein thrombosis? - Abstract
Background: Portal hypertension is caused by high resistance in portal system
due to hepatic fibrosis or pre-sinusoidal obstruction, such as seen in schistosomiasis.
The paraumbilical vein recanalization a frequent event in these patients seems to
be an efficient portal decompression pathway. A new incision avoiding ligation of
the round ligament for major surgeries at the upper abdominal quadrants in portal
hypertension patients is proposed: a left subcostal with a small median extension. This
incision offers excellent exposure of spleen, stomach, and esophagus whilst keeping the
paraumbilical vein intact. This allows to left an adequate flow in portal trunk.
Conclusion: The proposed technical modification proposed is an attractive option
because it can reduce the incidence of portal vein thrombosis and postoperative
bleeding from esophageal varices