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[Elective-selective Warren splenorenal shunt operation. Prognosis of liver function and esophageal varices hemorrhage after repeat sclerotherapy in liver cirrhosis].
Chirurg. 1991 Nov; 62(11):794-8; discussion 798-9.C

Abstract

From March 1st, 1982 to March 1st 1990 399 patients were admitted to the Heinz-Kalk-Hospital with recurrent bleeding from esophageal varices. Therapy of first choice was acute or elective endoscopic sclerotherapy. Early recurrences and uncontrollable hemorrhage were treated by Linton-Nachlas tube or if unsuccessful by devascularisation procedure. Two early or late bleeding recurrences were defined as sclerotherapy failures and choosen after passing a selection analysis (liver volume 1000 to 2500 ml, portal perfusion more than 30%, liver biopsy without activity or progression, exclusion of stenosis in the arterial supply of the liver and Child-Pugh classification A and B) for a selective-elective splenorenal Warren shunt (SRS). In 10 of 44 selected patients (11%) with an underlying disease of intrahepatic block in 95%, mostly alcoholic origin (65%) intraoperatively the performance of an SRS was technically problematic or impossible. Therefore, a mesocaval interposition shunt was carried out. Early mortality of 34 SRS was 5.9% (2 patients) and late mortality 17.6% (6 patients). No encephalopathy and shunt thrombosis were recorded. Postoperative angio- and sequential scintigraphies proved that portal perfusion was preserved during the first two years, but diminished. Liver function remained stable, too. One case of early rebleeding could be successfully managed by emergency endoscopic sclerotherapy. Five- and eight-years survival rate, according to the method of Kaplan-Meier is about 70%. We conclude that the SRS is the treatment of choice for elective management of recurrent bleeding of esophageal varices refractory to sclerotherapy. Its performance should be not enforced; in case of technical difficulties narrow-lumen mesocaval interposition shunt is an excellent alternative.

Authors+Show Affiliations

Paquet KJ
Department für Chirurgie und Gefässchirurgie, Heinz-Kalk-Krankenhauses Bad Kissingen.
Lazar A
No affiliation info available
Mercado MA
No affiliation info available
Gad HA
No affiliation info available

MeSH

AdolescentAdultAgedCombined Modality TherapyEsophageal and Gastric VaricesFemaleFollow-Up StudiesGastrointestinal HemorrhageGraft Occlusion, VascularHumansHypertension, PortalLiver CirrhosisLiver Cirrhosis, AlcoholicLiver Function TestsMaleMiddle AgedPostoperative ComplicationsRecurrenceSclerotherapySplenorenal Shunt, SurgicalSurvival Rate

Pub Type(s)

English Abstract
Journal Article

Language

ger

PubMed ID

1769259

Citation

Paquet, K J., et al. "[Elective-selective Warren Splenorenal Shunt Operation. Prognosis of Liver Function and Esophageal Varices Hemorrhage After Repeat Sclerotherapy in Liver Cirrhosis]." Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen, vol. 62, no. 11, 1991, pp. 794-8; discussion 798-9.
Paquet KJ, Lazar A, Mercado MA, et al. [Elective-selective Warren splenorenal shunt operation. Prognosis of liver function and esophageal varices hemorrhage after repeat sclerotherapy in liver cirrhosis]. Chirurg. 1991;62(11):794-8; discussion 798-9.
Paquet, K. J., Lazar, A., Mercado, M. A., & Gad, H. A. (1991). [Elective-selective Warren splenorenal shunt operation. Prognosis of liver function and esophageal varices hemorrhage after repeat sclerotherapy in liver cirrhosis]. Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen, 62(11), 794-8; discussion 798-9.
Paquet KJ, et al. [Elective-selective Warren Splenorenal Shunt Operation. Prognosis of Liver Function and Esophageal Varices Hemorrhage After Repeat Sclerotherapy in Liver Cirrhosis]. Chirurg. 1991;62(11):794-8; discussion 798-9. PubMed PMID: 1769259.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Elective-selective Warren splenorenal shunt operation. Prognosis of liver function and esophageal varices hemorrhage after repeat sclerotherapy in liver cirrhosis]. AU - Paquet,K J, AU - Lazar,A, AU - Mercado,M A, AU - Gad,H A, PY - 1991/11/1/pubmed PY - 1991/11/1/medline PY - 1991/11/1/entrez SP - 794-8; discussion 798-9 JF - Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen JO - Chirurg VL - 62 IS - 11 N2 - From March 1st, 1982 to March 1st 1990 399 patients were admitted to the Heinz-Kalk-Hospital with recurrent bleeding from esophageal varices. Therapy of first choice was acute or elective endoscopic sclerotherapy. Early recurrences and uncontrollable hemorrhage were treated by Linton-Nachlas tube or if unsuccessful by devascularisation procedure. Two early or late bleeding recurrences were defined as sclerotherapy failures and choosen after passing a selection analysis (liver volume 1000 to 2500 ml, portal perfusion more than 30%, liver biopsy without activity or progression, exclusion of stenosis in the arterial supply of the liver and Child-Pugh classification A and B) for a selective-elective splenorenal Warren shunt (SRS). In 10 of 44 selected patients (11%) with an underlying disease of intrahepatic block in 95%, mostly alcoholic origin (65%) intraoperatively the performance of an SRS was technically problematic or impossible. Therefore, a mesocaval interposition shunt was carried out. Early mortality of 34 SRS was 5.9% (2 patients) and late mortality 17.6% (6 patients). No encephalopathy and shunt thrombosis were recorded. Postoperative angio- and sequential scintigraphies proved that portal perfusion was preserved during the first two years, but diminished. Liver function remained stable, too. One case of early rebleeding could be successfully managed by emergency endoscopic sclerotherapy. Five- and eight-years survival rate, according to the method of Kaplan-Meier is about 70%. We conclude that the SRS is the treatment of choice for elective management of recurrent bleeding of esophageal varices refractory to sclerotherapy. Its performance should be not enforced; in case of technical difficulties narrow-lumen mesocaval interposition shunt is an excellent alternative. SN - 0009-4722 UR - https://www.unboundmedicine.com/medline/citation/1769259/[Elective_selective_Warren_splenorenal_shunt_operation__Prognosis_of_liver_function_and_esophageal_varices_hemorrhage_after_repeat_sclerotherapy_in_liver_cirrhosis]_ DB - PRIME DP - Unbound Medicine ER -