Surgical Approach to Portal Vein Thrombosis with Portal Hypertension: Challenges and Outcomes

Portal vein thrombosis (PVT) in the setting of portal hypertension represents a complex clinical entity requiring a multidisciplinary approach for optimal management. This article explores the indications, techniques, and outcomes of surgical interventions in patients with PVT complicated by portal hypertension. We provide an overview of the pathophysiological interplay between thrombosis and increased portal pressure, emphasizing the impact of underlying etiologies, including cirrhosis, malignancy, and prothrombotic disorders. Various surgical options, such as thrombectomy, meso-Rex bypass, and shunt procedures, are reviewed in the context of their efficacy, complications, and role in contemporary practice. Special attention is given to perioperative management strategies, including anticoagulation, hemodynamic stabilization, and prevention of recurrent thrombosis. By analyzing recent data and case studies, we aim to elucidate the potential benefits and risks of surgical treatment for this challenging condition, highlighting areas for future research and innovation.