Results of combined minimally invasive surgical treatment and prevention of portal hemorrhages in patients with liver cirrhosis

The main objective in performing staged minimally invasive surgical correction of portal hypertension, as a basis for the prevention and treatment of portal bleeding, is the correct selection of initial and subsequent interventions while adhering to the concept of an individualized approach. Objective. To improve the outcomes of treatment and prevention of portal bleeding in patients with liver cirrhosis. Material and research methods. A comparative controlled study was conducted on the treatment outcomes of 295 patients with cirrhotic portal hypertension between 2006 and 2025. Group 1 (n = 109) underwent staged combined minimally invasive surgical treatment and prevention of portal bleeding. Group 2 (n = 84) consisted of patients who received only endoscopic methods. Group 3 (n = 102) included patients who received only conservative therapy. Research results. The frequency of complications after endoscopic procedures didn’t depend on a history of bleeding and was the same in groups 1 and 2. The correlation between functional class and the development of complications after minimally invasive azygoportal disconnection (n = 65) was not statistically significant (p = 0.491). Inverse correlations were found between the initial sagittal size of the spleen and the baseline levels of thrombocytopenia and leukopenia in patients who received splenic blood flow reduction. After transjugular portosystemic shunting, regression of esophageal and gastric varices was noted in 81.58 % of cases (p < 0.0001). The most common combination was endoscopic band ligation of esophageal varices, azygoportal disconnection surgery, and splenic blood flow reduction (n = 21). The choice of the initial method depended on the presence or risk of bleeding. Group 3 had a much higher mortality (7 times higher) than group 2 (p < 0.0001). In group 1, the mortality rate is 3 times lower than in group 2 (p < 0.0001). Conclusion. The use of minimally invasive surgical correction of portal hypertension, following an individualized approach based on the predominant complication, allows for a reduction in mortality.

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