Name of the Procedure:

Venous anastomosis, open; portocaval

• Common Name: Portocaval Shunt Surgery
• Technical Terms: Portocaval Venous Anastomosis

Summary

Venous anastomosis, open; portocaval is a surgical procedure designed to create a direct connection between the portal vein and the inferior vena cava. This procedure helps to redirect blood flow and ease pressure in the portal vein.

Purpose

The procedure addresses conditions associated with high blood pressure in the portal vein, known as portal hypertension. The goals include:

• Reducing portal hypertension
• Preventing complications such as variceal bleeding
• Improving overall liver function

Indications

This procedure is indicated for patients with:

• Severe portal hypertension
• Complications like variceal bleeding, ascites, or hepatic encephalopathy
• Patients who have not responded to other treatments or for whom other treatments are not suitable

Preparation

Patients may need to:

• Fast for a specific period before surgery (usually 8-12 hours)
• Adjust or stop certain medications, as advised by their doctor
• Undergo pre-operative tests, including blood tests, liver function tests, and imaging studies like ultrasound or CT scans

Procedure Description

1. Anesthesia: General anesthesia is administered to put the patient to sleep.
2. Incision: A surgical incision is made in the abdomen to access the portal vein and inferior vena cava.
3. Connection: The surgeon carefully creates a connection between the portal vein and the inferior vena cava to allow blood to flow directly between these vessels.
4. Closure: The incision is closed with sutures or staples.
5. Monitoring: The patient is closely monitored during the procedure for any complications.

Tools and equipment include surgical clamps, sutures, and specialized vascular instruments.

Duration

The procedure typically takes between 2 to 4 hours.

Setting

The procedure is performed in a hospital operating room, often in a facility equipped with advanced surgical and monitoring technologies.

Personnel

• Primary Surgeon (often a specialized vascular or transplant surgeon)
• Surgical Nurses
• Anesthesiologist
• Surgical Assistants

Risks and Complications

• Common Risks: Bleeding, infection, and blood clots.
• Rare Risks: Liver failure, kidney issues, or heart complications.
• Management: Involves close monitoring, blood transfusions if necessary, and medications to manage complications.

Benefits

• Reduction in portal hypertension
• Decreased risk of variceal bleeding and related complications
• Improved quality of life
• Symptomatic relief may be realized gradually over a period of weeks to months.

Recovery

• Initial recovery requires a hospital stay of about 7-10 days.
• Post-procedure instructions include wound care, activity restrictions, and dietary modifications.
• Full recovery may take several weeks to months, and regular follow-up appointments are necessary to monitor liver function and overall health.

Alternatives

• Other treatment options include Transjugular Intrahepatic Portosystemic Shunt (TIPS), medication management, and lifestyle modifications.
• Pros and Cons: While less invasive, alternatives like TIPS may not be suitable for all patients and might not provide as long-lasting relief as surgical shunts.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-procedure, they may experience discomfort at the incision site, which can be managed with pain medications. Full recovery includes a gradual return to normal activities, but patients will need to adhere to medical advice and attend follow-up appointments for optimal outcomes.