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Distal splenorenal shunt: preferred treatment for recurrent variceal hemorrhage in the patient with well-compensated cirrhosis.
Arch Surg. 2006 Apr; 141(4):385-8; discussion 388.AS

Abstract

HYPOTHESIS

Distal splenorenal shunt (DSRS) is a safe and effective treatment for patients with Child-Pugh class A and B cirrhosis with recurrent variceal hemorrhage after failed transjugular intrahepatic portosystemic shunt.

DESIGN

Retrospective case review.

SETTING

Hepatobiliary surgery and liver transplantation department in a tertiary referral medical center.

PATIENTS

Between August 1, 1985, and May 1, 2005, 119 patients with Child-Pugh class A and B cirrhosis underwent DSRS for recurrent variceal hemorrhage. Of these, 17 (14.3%) had thrombosed or failing transjugular intrahepatic portosystemic shunt prior to DSRS.

INTERVENTION

Distal splenorenal shunt for recurrent variceal hemorrhage after failure of conservative management.

MAIN OUTCOME MEASURES

Morbidity, mortality, and subsequent liver transplantation rate.

RESULTS

The overall perioperative morbidity rate was 31.5%. Thirteen patients (11.7%) developed encephalopathy and 6 (5.4%) had recurrent variceal hemorrhage. Other complications included portal vein thrombosis, pancreatitis, pancreatic pseudocyst, pneumonia, and wound infection. The 30-day operative mortality rate was 6.4% (n = 7). The 1-year survival rate was 85.9%. The incidence of DSRS for failed transjugular intrahepatic portosystemic shunt during the first 12 years of the study (1985-1997) was 11.1% (9/81). This proportion increased to 26.7% (8/30) during the second half of the study (1997-2005). During the 20-year period, 15 patients (13.5%) underwent liver transplantation a mean of 5.1 years after DSRS without an increase in morbidity or mortality after transplantation.

CONCLUSIONS

Distal splenorenal shunt may be the preferred treatment for recurrent variceal hemorrhage in the patient with well-compensated cirrhosis. In addition, DSRS does not cause increased morbidity or mortality in subsequent liver transplantation.

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Authors+Show Affiliations

Elwood DR
Division of Hepatobiliary Surgery and Liver Transplantation, Lahey Clinic Medical Center, Burlington, Mass.
Pomposelli JJ
No affiliation info available
Pomfret EA
No affiliation info available
Lewis WD
No affiliation info available
Jenkins RL
No affiliation info available

MeSH

AdultAgedAged, 80 and overEsophageal and Gastric VaricesFemaleGastrointestinal HemorrhageHumansLiver CirrhosisLiver TransplantationMaleMiddle AgedPostoperative ComplicationsRecurrenceReoperationRetrospective StudiesSplenorenal Shunt, SurgicalSurvival RateTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16618897

Citation

Elwood, David R., et al. "Distal Splenorenal Shunt: Preferred Treatment for Recurrent Variceal Hemorrhage in the Patient With Well-compensated Cirrhosis." Archives of Surgery (Chicago, Ill. : 1960), vol. 141, no. 4, 2006, pp. 385-8; discussion 388.
Elwood DR, Pomposelli JJ, Pomfret EA, et al. Distal splenorenal shunt: preferred treatment for recurrent variceal hemorrhage in the patient with well-compensated cirrhosis. Arch Surg. 2006;141(4):385-8; discussion 388.
Elwood, D. R., Pomposelli, J. J., Pomfret, E. A., Lewis, W. D., & Jenkins, R. L. (2006). Distal splenorenal shunt: preferred treatment for recurrent variceal hemorrhage in the patient with well-compensated cirrhosis. Archives of Surgery (Chicago, Ill. : 1960), 141(4), 385-8; discussion 388.
Elwood DR, et al. Distal Splenorenal Shunt: Preferred Treatment for Recurrent Variceal Hemorrhage in the Patient With Well-compensated Cirrhosis. Arch Surg. 2006;141(4):385-8; discussion 388. PubMed PMID: 16618897.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Distal splenorenal shunt: preferred treatment for recurrent variceal hemorrhage in the patient with well-compensated cirrhosis. AU - Elwood,David R, AU - Pomposelli,James J, AU - Pomfret,Elizabeth A, AU - Lewis,W David, AU - Jenkins,Roger L, PY - 2006/4/19/pubmed PY - 2006/5/12/medline PY - 2006/4/19/entrez SP - 385-8; discussion 388 JF - Archives of surgery (Chicago, Ill. : 1960) JO - Arch Surg VL - 141 IS - 4 N2 - HYPOTHESIS: Distal splenorenal shunt (DSRS) is a safe and effective treatment for patients with Child-Pugh class A and B cirrhosis with recurrent variceal hemorrhage after failed transjugular intrahepatic portosystemic shunt. DESIGN: Retrospective case review. SETTING: Hepatobiliary surgery and liver transplantation department in a tertiary referral medical center. PATIENTS: Between August 1, 1985, and May 1, 2005, 119 patients with Child-Pugh class A and B cirrhosis underwent DSRS for recurrent variceal hemorrhage. Of these, 17 (14.3%) had thrombosed or failing transjugular intrahepatic portosystemic shunt prior to DSRS. INTERVENTION: Distal splenorenal shunt for recurrent variceal hemorrhage after failure of conservative management. MAIN OUTCOME MEASURES: Morbidity, mortality, and subsequent liver transplantation rate. RESULTS: The overall perioperative morbidity rate was 31.5%. Thirteen patients (11.7%) developed encephalopathy and 6 (5.4%) had recurrent variceal hemorrhage. Other complications included portal vein thrombosis, pancreatitis, pancreatic pseudocyst, pneumonia, and wound infection. The 30-day operative mortality rate was 6.4% (n = 7). The 1-year survival rate was 85.9%. The incidence of DSRS for failed transjugular intrahepatic portosystemic shunt during the first 12 years of the study (1985-1997) was 11.1% (9/81). This proportion increased to 26.7% (8/30) during the second half of the study (1997-2005). During the 20-year period, 15 patients (13.5%) underwent liver transplantation a mean of 5.1 years after DSRS without an increase in morbidity or mortality after transplantation. CONCLUSIONS: Distal splenorenal shunt may be the preferred treatment for recurrent variceal hemorrhage in the patient with well-compensated cirrhosis. In addition, DSRS does not cause increased morbidity or mortality in subsequent liver transplantation. SN - 0004-0010 UR - https://www.unboundmedicine.com/medline/citation/16618897/Distal_splenorenal_shunt:_preferred_treatment_for_recurrent_variceal_hemorrhage_in_the_patient_with_well_compensated_cirrhosis_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/archsurg.141.4.385 DB - PRIME DP - Unbound Medicine ER -