Portal Hypertension

Portal hypertension is defined as elevated pressure in the portal venous system — the network of veins that carries blood from the gastrointestinal tract, spleen, and pancreas to the liver. Normal portal pressure is 5–10 mmHg; clinically significant portal hypertension occurs when the hepatic venous pressure gradient (HVPG) exceeds 10 mmHg. The most common cause is liver cirrhosis, where scarring and architectural distortion increase resistance to portal blood flow. Other causes include non-cirrhotic portal fibrosis (NCPF), extrahepatic portal vein obstruction (EHPVO), Budd-Chiari syndrome, and schistosomiasis.

The clinical consequences of portal hypertension are severe and potentially life-threatening. The development of oesophageal and gastric varices — dilated collateral veins that form as blood seeks alternative routes — carries a risk of catastrophic bleeding (haematemesis or melaena) with mortality rates of 15–20% per episode. Other complications include ascites (fluid in the abdomen), splenomegaly with hypersplenism (low platelets and anaemia), hepatic encephalopathy, and hepatorenal syndrome. Non-selective beta-blockers (propranolol, carvedilol) and endoscopic variceal band ligation form the cornerstone of primary and secondary prophylaxis for variceal bleeding.

Surgical management of portal hypertension includes portosystemic shunts (selective shunts such as distal splenorenal shunt, and non-selective shunts), devascularisation procedures (Sugiura's operation), and splenectomy for symptomatic hypersplenism. Transjugular intrahepatic portosystemic shunt (TIPS) is a radiological intervention that creates a channel within the liver to decompress the portal circulation. However, in patients with cirrhosis and refractory portal hypertension complications, liver transplantation remains the definitive treatment — simultaneously correcting the underlying liver disease and reversing portal hypertension. Our team provides comprehensive assessment and individualised surgical planning for all patients with portal hypertension.