MESOCAVAL SHUNTS FOR THE CONTROL OF BLEEDING ESOPHAGEAL-VARICES

  • 1 January 1979
    • journal article
    • research article
    • Vol. 85  (3) , 257-262
Abstract
Results in 44 patients with esophageal bleeding who underwent a mesocaval shunt utilizing a prosthetic graft are presented. Portal hypertension was secondary in alcoholic cirrhosis in 30 patients, to chronic active hepatitis in 8, to primary biliary cirrhosis in 4, to cirrhosis secondary to inflammatory bowel disease in 1, and to portal vein thrombosis following splenectomy in 1. Shunt [36] were performed during the emergent or semiemergent time period, and only 8 were performed electively. Of the patients 16 were Child''s class A, 16 were class B, and 12 were class C. There were no hospital deaths in the emergency shunt group (of 8 patients). There was a 12% mortality rate for patients undergoing semiemergency shunts (2 of 17 patients) and a 42% mortality rate for patients who had emergency shunts (8 of 19 patients). Death was related more closely to hepatic reserve than to timing of the shunt. Among the 32 class A and class B patients, there were only 3 deaths in hospital (9%), as compared with 7 deaths among the 12 class C patients (58%). Portal-systemic encephalopathy was high in the period immediately after operation (13 of 34 patients, 38%), but it was a chronic problem following discharge from the hospital in only three of 34 patients (9%). The mesocaval shunt is a safe, effective procedure for the control of variceal bleeding in class A and B patients in any time period, but it carries a high operative mortality risk in the class C patient when it is performed as an emergency operation.

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