Liver disease surgery versus liver transplantation

  The current treatments for cirrhotic portal hypertension are mainly conservative and surgical. Most patients end up undergoing surgery. This is because the patient’s hypersplenism can only be resolved by surgery. Also there are different methods of surgery. The main ones are flow disconnection and shunt. The disconnection surgery is relatively simple and can be carried out in most county hospitals, but the venous bypass surgery is technically demanding and time consuming and expensive, so most hospitals do not carry it out, and only our First Affiliated Hospital of Guangzhou Medical College can carry it out in Guangzhou, and not many hospitals such as the First Affiliated Hospital of Zhengzhou University, Shanghai Oriental Hepatobiliary Surgery, Peking University People’s Hospital, and Tangdu Hospital of the Fourth Military Medical University in Xi’an. However, the long-term efficacy of bypass surgery is significantly better than that of disconnection surgery. Combined, flow disconnection surgery is highly purposeful and has exact short-term hemostasis, while bypass surgery has good long-term results. The most commonly used bypass procedure is splenic vein-renal vein shunt.  Thus in practice, the best current surgical approach is flow disconnection with bypass, with long-term results comparable to liver transplantation, with most patients surviving more than 10 years, while liver transplantation rarely exceeds 10 years. However, the short-term surgical risk of liver transplantation is high and the long-term medical cost is more than 10 times more than that of shunt. Moreover, nowadays, many doctors in hospitals with the ability to do liver transplantation have the excessive behavior of misjudging early and mid-stage cirrhosis as end-stage cirrhosis in order to do liver transplantation. Therefore, the best surgical method for cirrhotic portal hypertension is still bypass surgery. Patients are advised to go to a hospital that has the ability to perform bypass surgery for the treatment of cirrhotic portal hypertension.