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Liver function and encephalopathy after partial vs direct side-to-side portacaval shunt: a prospective randomized clinical trial.
Surgery. 2000 Jun; 127(6):614-21.S

Abstract

BACKGROUND

The aim of this study was to determine, in a prospective randomized clinical trial, whether the partial portacaval shunt offers any advantage in terms of liver function and encephalopathy rate when compared with direct side-to-side direct portacaval shunt.

METHODS

Forty-six "good risk" patients with cirrhosis and with documented variceal hemorrhage were randomly assigned to either a partial shunt procedure (achieved by 10-mm diameter interposition portacaval H-graft) or direct small-diameter side-to-side portacaval anastomosis.

RESULTS

Operative mortality was zero in both groups. During the follow-up period, encephalopathy developed in 3 patients in the partial shunt group and 9 in the direct shunt group (P =.04). Kaplan-Meier analysis demonstrated that encephalopathy-free survival was significantly longer in the partial shunt group (P =.025). Direct shunt patients had significant hepatic functional deterioration postoperatively compared with the partial shunt group.

CONCLUSIONS

The partial portacaval shunt effectively controls variceal hemorrhage. Compared with direct side-to-side portacaval shunt, partial shunt preserves long-term hepatic function and minimizes postoperative encephalopathy. We conclude that the partial portacaval shunt is the preferred approach over direct shunts for patients with cirrhosis and with variceal bleeding.

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Authors+Show Affiliations

Capussotti L
Departments of Surgery and Gastroenterology, Ospedale Mauriziano (Umberto I), Torino, Italy.
Vergara V
No affiliation info available
Polastri R
No affiliation info available
Bouzari H
No affiliation info available
Galatola G
No affiliation info available

MeSH

AgedEsophageal and Gastric VaricesFemaleGastrointestinal HemorrhageHepatic EncephalopathyHumansLiverLiver CirrhosisMaleMiddle AgedPortacaval Shunt, SurgicalPostoperative ComplicationsProspective StudiesRecurrence

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

10840355

Citation

Capussotti, L, et al. "Liver Function and Encephalopathy After Partial Vs Direct Side-to-side Portacaval Shunt: a Prospective Randomized Clinical Trial." Surgery, vol. 127, no. 6, 2000, pp. 614-21.
Capussotti L, Vergara V, Polastri R, et al. Liver function and encephalopathy after partial vs direct side-to-side portacaval shunt: a prospective randomized clinical trial. Surgery. 2000;127(6):614-21.
Capussotti, L., Vergara, V., Polastri, R., Bouzari, H., & Galatola, G. (2000). Liver function and encephalopathy after partial vs direct side-to-side portacaval shunt: a prospective randomized clinical trial. Surgery, 127(6), 614-21.
Capussotti L, et al. Liver Function and Encephalopathy After Partial Vs Direct Side-to-side Portacaval Shunt: a Prospective Randomized Clinical Trial. Surgery. 2000;127(6):614-21. PubMed PMID: 10840355.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Liver function and encephalopathy after partial vs direct side-to-side portacaval shunt: a prospective randomized clinical trial. AU - Capussotti,L, AU - Vergara,V, AU - Polastri,R, AU - Bouzari,H, AU - Galatola,G, PY - 2000/6/7/pubmed PY - 2000/8/1/medline PY - 2000/6/7/entrez SP - 614 EP - 21 JF - Surgery JO - Surgery VL - 127 IS - 6 N2 - BACKGROUND: The aim of this study was to determine, in a prospective randomized clinical trial, whether the partial portacaval shunt offers any advantage in terms of liver function and encephalopathy rate when compared with direct side-to-side direct portacaval shunt. METHODS: Forty-six "good risk" patients with cirrhosis and with documented variceal hemorrhage were randomly assigned to either a partial shunt procedure (achieved by 10-mm diameter interposition portacaval H-graft) or direct small-diameter side-to-side portacaval anastomosis. RESULTS: Operative mortality was zero in both groups. During the follow-up period, encephalopathy developed in 3 patients in the partial shunt group and 9 in the direct shunt group (P =.04). Kaplan-Meier analysis demonstrated that encephalopathy-free survival was significantly longer in the partial shunt group (P =.025). Direct shunt patients had significant hepatic functional deterioration postoperatively compared with the partial shunt group. CONCLUSIONS: The partial portacaval shunt effectively controls variceal hemorrhage. Compared with direct side-to-side portacaval shunt, partial shunt preserves long-term hepatic function and minimizes postoperative encephalopathy. We conclude that the partial portacaval shunt is the preferred approach over direct shunts for patients with cirrhosis and with variceal bleeding. SN - 0039-6060 UR - https://www.unboundmedicine.com/medline/citation/10840355/Liver_function_and_encephalopathy_after_partial_vs_direct_side_to_side_portacaval_shunt:_a_prospective_randomized_clinical_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0039-6060(00)06361-3 DB - PRIME DP - Unbound Medicine ER -