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Current state of portosystemic shunt surgery.
Langenbecks Arch Surg. 2003 Jul; 388(3):141-9.LA

Abstract

BACKGROUND

A switch to decompressive shunt procedures is mandatory if endoscopic therapy fails to control recurrent variceal hemorrhage. Surgical shunt procedures continue to be safe, highly effective, and durable procedures to treat variceal bleeding in patients with low operative risk and good liver function.

DISCUSSION

In cirrhotics, elective operations using portal flow preserving techniques such as a selective distal splenorenal shunt (Warren) and a partial portocaval small diameter interposition shunt (Sarfeh) should be preferred. Rarely, end-to-side portocaval shunt may serve as a salvage procedure if emergency endoscopic treatment or transjugular intrahepatic portosystemic shunt insertion fails to stop bleeding. Until definitive results from randomized trials are available patients with good prognosis (Child-Pugh A and B) should be regarded as candidates for surgical shunts. For patients with noncirrhotic portal hypertension, in particular with extrahepatic portal vein thrombosis, portosystemic shunt surgery represents the only effective therapy which leads to freedom of recurrent bleeding and repeated endoscopies for many years, and improves hypersplenism without deteriorating liver function or encephalopathy. Gastroesophageal devascularization and other direct variceal ablative procedures should be restricted to treat endoscopic therapy failures without shuntable portal tributaries.

Authors+Show Affiliations

Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefässchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany. wolff@chir.uni-bonn.deNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

12942328

Citation

Wolff, Martin, and Andreas Hirner. "Current State of Portosystemic Shunt Surgery." Langenbeck's Archives of Surgery, vol. 388, no. 3, 2003, pp. 141-9.
Wolff M, Hirner A. Current state of portosystemic shunt surgery. Langenbecks Arch Surg. 2003;388(3):141-9.
Wolff, M., & Hirner, A. (2003). Current state of portosystemic shunt surgery. Langenbeck's Archives of Surgery, 388(3), 141-9.
Wolff M, Hirner A. Current State of Portosystemic Shunt Surgery. Langenbecks Arch Surg. 2003;388(3):141-9. PubMed PMID: 12942328.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Current state of portosystemic shunt surgery. AU - Wolff,Martin, AU - Hirner,Andreas, Y1 - 2003/03/29/ PY - 2003/02/13/received PY - 2003/02/17/accepted PY - 2003/8/28/pubmed PY - 2004/1/22/medline PY - 2003/8/28/entrez SP - 141 EP - 9 JF - Langenbeck's archives of surgery JO - Langenbecks Arch Surg VL - 388 IS - 3 N2 - BACKGROUND: A switch to decompressive shunt procedures is mandatory if endoscopic therapy fails to control recurrent variceal hemorrhage. Surgical shunt procedures continue to be safe, highly effective, and durable procedures to treat variceal bleeding in patients with low operative risk and good liver function. DISCUSSION: In cirrhotics, elective operations using portal flow preserving techniques such as a selective distal splenorenal shunt (Warren) and a partial portocaval small diameter interposition shunt (Sarfeh) should be preferred. Rarely, end-to-side portocaval shunt may serve as a salvage procedure if emergency endoscopic treatment or transjugular intrahepatic portosystemic shunt insertion fails to stop bleeding. Until definitive results from randomized trials are available patients with good prognosis (Child-Pugh A and B) should be regarded as candidates for surgical shunts. For patients with noncirrhotic portal hypertension, in particular with extrahepatic portal vein thrombosis, portosystemic shunt surgery represents the only effective therapy which leads to freedom of recurrent bleeding and repeated endoscopies for many years, and improves hypersplenism without deteriorating liver function or encephalopathy. Gastroesophageal devascularization and other direct variceal ablative procedures should be restricted to treat endoscopic therapy failures without shuntable portal tributaries. SN - 1435-2443 UR - https://www.unboundmedicine.com/medline/citation/12942328/Current_state_of_portosystemic_shunt_surgery_ L2 - https://dx.doi.org/10.1007/s00423-003-0367-5 DB - PRIME DP - Unbound Medicine ER -