Tags

Type your tag names separated by a space and hit enter

Should both schistosomal and nonschistosomal variceal bleeders be disconnected?
World J Surg. 1991 May-Jun; 15(3):389-97; discussion 398.WJ

Abstract

Splenopancreatic disconnection (SPD) was conceived and implemented as a technical addition to distal splenorenal shunt (DSRS) to maintain its selectivity and preserve portal perfusion. The proposed hemodynamic and metabolic stability of hepatocytes after DSRS-SPD should improve survival. In this nonrandomized study, 145 consecutive (Child A/B) variceal bleeders were electively subjected to selective shunt with DSRS in 93 and DSRS-SPD in 52 patients. The 2 groups were similar before surgery with a mean follow up of 24 +/- 12 (DSRS) and 27 +/- 14 (DSRS-SPD) months. DSRS-SPD had an operative mortality of 3.8%. Postoperative pancreatitis occurred in 7.7% after DSRS-SPD and 3.2% after DSRS alone, with schistosomal hepatic fibrosis representing 86% of morbid cases. Shunt patency was high and recurrent variceal hemorrhage was low in both groups. Clinical encephalopathy was significantly reduced after DSRS-SPD (p less than 0.05). The addition of SPD significantly reduced both the incidence of chronic hyperbilirubinemia in the schistosomal patients (p less than 0.05) and the difference between the changes in total serum bilirubin in all patients (p = 0.001). Portal perfusion was preserved after DSRS-SPD in all of the angiographically-studied patients. The overall survival was 84% after DSRS and 88% after DSRS-SPD. The schistosomal patients showed an incidence of 95% and 96% survival after DSRS and DSRS-SPD, respectively. DSRS-SPD was able to improve survival (92%) better than DSRS (77%) among well-matched nonschistosomal patients. These data show: (1) DSRS-SPD still has low operative mortality and a high patency rate with a low incidence of recurrent variceal hemorrhage, (2) DSRS-SPD maintains portal perfusion, achieves better survival, and reduces the incidence of encephalopathy, especially in patients with nonalcoholic cirrhosis and mixed liver disease, (3) in the schistosomal population, DSRS-SPD reduces the incidence of chronic hyperbilirubinemia but increases the risk of postoperative pancreatitis.

Authors+Show Affiliations

Department of Surgery, Mansoura University School of Medicine, Egypt.No 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

Language

eng

PubMed ID

1853619

Citation

Abu-Elmagd, K M., et al. "Should Both Schistosomal and Nonschistosomal Variceal Bleeders Be Disconnected?" World Journal of Surgery, vol. 15, no. 3, 1991, pp. 389-97; discussion 398.
Abu-Elmagd KM, Ezzat FA, Fathy OM, et al. Should both schistosomal and nonschistosomal variceal bleeders be disconnected? World J Surg. 1991;15(3):389-97; discussion 398.
Abu-Elmagd, K. M., Ezzat, F. A., Fathy, O. M., el-Ghawlby, N. A., Aly, M. A., el-Fiky, A. M., el-Barbary, M. H., el-Ebady, G. E., & el-Hak, N. G. (1991). Should both schistosomal and nonschistosomal variceal bleeders be disconnected? World Journal of Surgery, 15(3), 389-97; discussion 398.
Abu-Elmagd KM, et al. Should Both Schistosomal and Nonschistosomal Variceal Bleeders Be Disconnected. World J Surg. 1991 May-Jun;15(3):389-97; discussion 398. PubMed PMID: 1853619.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Should both schistosomal and nonschistosomal variceal bleeders be disconnected? AU - Abu-Elmagd,K M, AU - Ezzat,F A, AU - Fathy,O M, AU - el-Ghawlby,N A, AU - Aly,M A, AU - el-Fiky,A M, AU - el-Barbary,M H, AU - el-Ebady,G E, AU - el-Hak,N G, PY - 1991/5/1/pubmed PY - 1991/5/1/medline PY - 1991/5/1/entrez SP - 389-97; discussion 398 JF - World journal of surgery JO - World J Surg VL - 15 IS - 3 N2 - Splenopancreatic disconnection (SPD) was conceived and implemented as a technical addition to distal splenorenal shunt (DSRS) to maintain its selectivity and preserve portal perfusion. The proposed hemodynamic and metabolic stability of hepatocytes after DSRS-SPD should improve survival. In this nonrandomized study, 145 consecutive (Child A/B) variceal bleeders were electively subjected to selective shunt with DSRS in 93 and DSRS-SPD in 52 patients. The 2 groups were similar before surgery with a mean follow up of 24 +/- 12 (DSRS) and 27 +/- 14 (DSRS-SPD) months. DSRS-SPD had an operative mortality of 3.8%. Postoperative pancreatitis occurred in 7.7% after DSRS-SPD and 3.2% after DSRS alone, with schistosomal hepatic fibrosis representing 86% of morbid cases. Shunt patency was high and recurrent variceal hemorrhage was low in both groups. Clinical encephalopathy was significantly reduced after DSRS-SPD (p less than 0.05). The addition of SPD significantly reduced both the incidence of chronic hyperbilirubinemia in the schistosomal patients (p less than 0.05) and the difference between the changes in total serum bilirubin in all patients (p = 0.001). Portal perfusion was preserved after DSRS-SPD in all of the angiographically-studied patients. The overall survival was 84% after DSRS and 88% after DSRS-SPD. The schistosomal patients showed an incidence of 95% and 96% survival after DSRS and DSRS-SPD, respectively. DSRS-SPD was able to improve survival (92%) better than DSRS (77%) among well-matched nonschistosomal patients. These data show: (1) DSRS-SPD still has low operative mortality and a high patency rate with a low incidence of recurrent variceal hemorrhage, (2) DSRS-SPD maintains portal perfusion, achieves better survival, and reduces the incidence of encephalopathy, especially in patients with nonalcoholic cirrhosis and mixed liver disease, (3) in the schistosomal population, DSRS-SPD reduces the incidence of chronic hyperbilirubinemia but increases the risk of postoperative pancreatitis. SN - 0364-2313 UR - https://www.unboundmedicine.com/medline/citation/1853619/Should_both_schistosomal_and_nonschistosomal_variceal_bleeders_be_disconnected L2 - https://medlineplus.gov/cirrhosis.html DB - PRIME DP - Unbound Medicine ER -