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Portacaval shunt as emergency procedure in unselected patients with alcoholic cirrhosis.
Surg Gynecol Obstet. 1975 Jul; 141(1):59-68.SG

Abstract

A prospective evaluation of emergency portacaval shunt has been conducted during a 12 year period in 138 unselected, consecutive patients with alcoholic cirrhosis and bleeding esophageal varies. An extensive diagnostic evaluation was completed within seven hours of hospital admission, and the shunt operation was undertaken within a mean of 8.5 hours. Follow-up study was conducted in a special clinic, and the current status of 97.1 per cent of the patients had jaundice, ascites or encephalopathy alone or in combination on admission. Systemic intravenous administration of posterior pituitary extract temporarily controlled the hemorrhage in 94 per cent of the patients, and the emergency portacaval shunt promptly and permanently controlled the varix bleeding in 96 per cent of the patients. Contrary to recent proposals, patients with the highest portal perfusion pressure and, presumably, the largest hepatopetal portal flow had the highest survival rate and those who were presumed from pressure measurements to sustain the smallest portal flow diversion from the shunt had the lowest survival rate. The operative survival rate was 51 per cent, the predicted seven year survival rate for those operated upon seven or more years ago was 42.5 per cent. Encephalopathy requiring dietary protein restriction developed at some time in 17 per cent of the survivors. Sixty per cent of the survivors abstained from alcohol, and 53 per cent resumed gainful employment or full time housekeeping. Preoperative factors that adversely influenced survial rate were ingestion of alcohol within one month of bleeding, ascites, severe muscle-wasting and a small liver. Postoperatively, the single most important factor that compromised long term survival was resumption of alcoholism. In comparisons with our previous prospective studies, emergency portacaval shunt resulted in a significantly greater long term survival rate than did either emergency medical therapy or emergency varix ligation, followed by elective shunt. It is concluded that emergency portacaval shunt is the most effective treatment of bleeding esophageal varices in patients with alcoholic cirrhosis. Criteria for exclusion of those patients who are unlikely to derive long term benefits from portacaval shunt remain to be defined by further studies.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

1154215

Citation

Orloff, M J., et al. "Portacaval Shunt as Emergency Procedure in Unselected Patients With Alcoholic Cirrhosis." Surgery, Gynecology & Obstetrics, vol. 141, no. 1, 1975, pp. 59-68.
Orloff MJ, Charters AC, Chandler JG, et al. Portacaval shunt as emergency procedure in unselected patients with alcoholic cirrhosis. Surg Gynecol Obstet. 1975;141(1):59-68.
Orloff, M. J., Charters, A. C., Chandler, J. G., Condon, J. K., Grambort, D. E., Modafferi, T. R., Levin, S. E., Brown, N. B., Sviokla, S. C., & Knox, D. G. (1975). Portacaval shunt as emergency procedure in unselected patients with alcoholic cirrhosis. Surgery, Gynecology & Obstetrics, 141(1), 59-68.
Orloff MJ, et al. Portacaval Shunt as Emergency Procedure in Unselected Patients With Alcoholic Cirrhosis. Surg Gynecol Obstet. 1975;141(1):59-68. PubMed PMID: 1154215.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Portacaval shunt as emergency procedure in unselected patients with alcoholic cirrhosis. AU - Orloff,M J, AU - Charters,A C,3rd AU - Chandler,J G, AU - Condon,J K, AU - Grambort,D E, AU - Modafferi,T R, AU - Levin,S E, AU - Brown,N B, AU - Sviokla,S C, AU - Knox,D G, PY - 1975/7/1/pubmed PY - 1975/7/1/medline PY - 1975/7/1/entrez SP - 59 EP - 68 JF - Surgery, gynecology & obstetrics JO - Surg Gynecol Obstet VL - 141 IS - 1 N2 - A prospective evaluation of emergency portacaval shunt has been conducted during a 12 year period in 138 unselected, consecutive patients with alcoholic cirrhosis and bleeding esophageal varies. An extensive diagnostic evaluation was completed within seven hours of hospital admission, and the shunt operation was undertaken within a mean of 8.5 hours. Follow-up study was conducted in a special clinic, and the current status of 97.1 per cent of the patients had jaundice, ascites or encephalopathy alone or in combination on admission. Systemic intravenous administration of posterior pituitary extract temporarily controlled the hemorrhage in 94 per cent of the patients, and the emergency portacaval shunt promptly and permanently controlled the varix bleeding in 96 per cent of the patients. Contrary to recent proposals, patients with the highest portal perfusion pressure and, presumably, the largest hepatopetal portal flow had the highest survival rate and those who were presumed from pressure measurements to sustain the smallest portal flow diversion from the shunt had the lowest survival rate. The operative survival rate was 51 per cent, the predicted seven year survival rate for those operated upon seven or more years ago was 42.5 per cent. Encephalopathy requiring dietary protein restriction developed at some time in 17 per cent of the survivors. Sixty per cent of the survivors abstained from alcohol, and 53 per cent resumed gainful employment or full time housekeeping. Preoperative factors that adversely influenced survial rate were ingestion of alcohol within one month of bleeding, ascites, severe muscle-wasting and a small liver. Postoperatively, the single most important factor that compromised long term survival was resumption of alcoholism. In comparisons with our previous prospective studies, emergency portacaval shunt resulted in a significantly greater long term survival rate than did either emergency medical therapy or emergency varix ligation, followed by elective shunt. It is concluded that emergency portacaval shunt is the most effective treatment of bleeding esophageal varices in patients with alcoholic cirrhosis. Criteria for exclusion of those patients who are unlikely to derive long term benefits from portacaval shunt remain to be defined by further studies. SN - 0039-6087 UR - https://www.unboundmedicine.com/medline/citation/1154215/Portacaval_shunt_as_emergency_procedure_in_unselected_patients_with_alcoholic_cirrhosis_ DB - PRIME DP - Unbound Medicine ER -