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Long-term results of mesocaval shunts with polytetrafluoroethylene grafts.
Int Surg. 2008 Sep-Oct; 93(5):268-73.IS

Abstract

Despite the introduction of new procedures such as pharmacologic reduction of portal pressure and endoscopic sclerotherapy, the role of surgery in portal hypertension must be reconsidered. The aim of this retrospective study was to evaluate the long-term results of mesocaval interposition shunting in the treatment of recurrent variceal bleeding after sclerotherapy failure or in patients with intractable ascites in whom optimal medical treatments failed. Over a 20-year period, 85 patients (66 men and 19 women; mean age, 53.96 +/- 11.57 years) underwent a mesocaval interposition shunt procedure. Sixty-six patients had recurrent variceal bleeding, and 19 patients had refractory ascites. The underlying etiology of portal hypertension was alcoholic cirrhosis (n = 69), posthepatitis cirrhosis (n = 10), cryptogenic cirrhosis (n = 3), primary biliary cirrhosis (n = 2), and Budd-Chiari syndrome (n = 1). Thirty-one patients were in Child-Pugh grade A, 34 were in grade B, and 20 were in grade C. The mean diameter of the graft was 11.85 +/- 1.53 mm (range, 10-14 mm). Overall, in-hospital mortality was 10.5% (9 of 85 patients). There were 3 postoperative recurrences of variceal hemorrhage and 5 recurrent bleeds during the follow-up. The overall incidence of shunt thrombosis of this series was 10.5%. The total incidence of encephalopathy was 10.5%. Intraoperative gradient pressure measurements before and after shunt showed satisfactory pressure reduction (16.90 +/- 5.32 to 5.12 +/- 2.50/ mmHg; P < 0.0001). The mean follow-up period was 26.09 +/- 25.3 (range, 1-90) months. Nine patients (10.5%) later received liver transplants, with time intervals ranging from 2 months to 5 years. The actuarial survival rate was 92% at 1 year and 75% at 5 years. In our series, the interposition mesocaval shunt seems to be an effective procedure for the control of complications of portal hypertension in cirrhotic patients with good long-term results. Moreover, the procedure can be considered as a solution of choice in patients who are current liver transplant candidates, leaving the hepatic hilus intact.

Authors+Show Affiliations

Department of Visceral Surgery and Transplantation, Dupuytren University Hospital, Limoges Cedex, France.No 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

19943428

Citation

Descottes, Bernard, et al. "Long-term Results of Mesocaval Shunts With Polytetrafluoroethylene Grafts." International Surgery, vol. 93, no. 5, 2008, pp. 268-73.
Descottes B, Lachachi F, Maisonnette F, et al. Long-term results of mesocaval shunts with polytetrafluoroethylene grafts. Int Surg. 2008;93(5):268-73.
Descottes, B., Lachachi, F., Maisonnette, F., Durand-Fontanier, S., Abita, T., Geballa, R., & Valleix, D. (2008). Long-term results of mesocaval shunts with polytetrafluoroethylene grafts. International Surgery, 93(5), 268-73.
Descottes B, et al. Long-term Results of Mesocaval Shunts With Polytetrafluoroethylene Grafts. Int Surg. 2008 Sep-Oct;93(5):268-73. PubMed PMID: 19943428.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term results of mesocaval shunts with polytetrafluoroethylene grafts. AU - Descottes,Bernard, AU - Lachachi,Fouzi, AU - Maisonnette,Franck, AU - Durand-Fontanier,Sylvaine, AU - Abita,Thiare, AU - Geballa,Rami, AU - Valleix,Denis, PY - 2009/12/1/entrez PY - 2008/9/1/pubmed PY - 2009/12/23/medline SP - 268 EP - 73 JF - International surgery JO - Int Surg VL - 93 IS - 5 N2 - Despite the introduction of new procedures such as pharmacologic reduction of portal pressure and endoscopic sclerotherapy, the role of surgery in portal hypertension must be reconsidered. The aim of this retrospective study was to evaluate the long-term results of mesocaval interposition shunting in the treatment of recurrent variceal bleeding after sclerotherapy failure or in patients with intractable ascites in whom optimal medical treatments failed. Over a 20-year period, 85 patients (66 men and 19 women; mean age, 53.96 +/- 11.57 years) underwent a mesocaval interposition shunt procedure. Sixty-six patients had recurrent variceal bleeding, and 19 patients had refractory ascites. The underlying etiology of portal hypertension was alcoholic cirrhosis (n = 69), posthepatitis cirrhosis (n = 10), cryptogenic cirrhosis (n = 3), primary biliary cirrhosis (n = 2), and Budd-Chiari syndrome (n = 1). Thirty-one patients were in Child-Pugh grade A, 34 were in grade B, and 20 were in grade C. The mean diameter of the graft was 11.85 +/- 1.53 mm (range, 10-14 mm). Overall, in-hospital mortality was 10.5% (9 of 85 patients). There were 3 postoperative recurrences of variceal hemorrhage and 5 recurrent bleeds during the follow-up. The overall incidence of shunt thrombosis of this series was 10.5%. The total incidence of encephalopathy was 10.5%. Intraoperative gradient pressure measurements before and after shunt showed satisfactory pressure reduction (16.90 +/- 5.32 to 5.12 +/- 2.50/ mmHg; P < 0.0001). The mean follow-up period was 26.09 +/- 25.3 (range, 1-90) months. Nine patients (10.5%) later received liver transplants, with time intervals ranging from 2 months to 5 years. The actuarial survival rate was 92% at 1 year and 75% at 5 years. In our series, the interposition mesocaval shunt seems to be an effective procedure for the control of complications of portal hypertension in cirrhotic patients with good long-term results. Moreover, the procedure can be considered as a solution of choice in patients who are current liver transplant candidates, leaving the hepatic hilus intact. SN - 0020-8868 UR - https://www.unboundmedicine.com/medline/citation/19943428/Long_term_results_of_mesocaval_shunts_with_polytetrafluoroethylene_grafts_ L2 - https://medlineplus.gov/gastrointestinalbleeding.html DB - PRIME DP - Unbound Medicine ER -