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100 meso-caval interposition-shunts for recurrent variceal hemorrhage in portal hypertension. A prospective study.
Rev Invest Clin. 1989 Oct-Dec; 41(4):309-17.RI

Abstract

The results of a prospective series using the mesocaval interposition shunt (MIS) over a period of 13 years is reviewed: 100 patients were selected for the operation using strict criteria and in 98 cases the operation was performed electively. Selection criteria included liver volume between 1000-2500 mL, portal perfusion between 15-30%, no active liver disease and no stenosis of hepatic artery or coeliac axis as well as a good functional CHILD-PUGH classification (A-B). In all the cases preoperative sclerotherapy was performed so many times as needed by each individual patient with the goal of controlling the active bleeding episodes at admission and of diminishing the pre and postoperative bleeding probability. Intraoperative postshunt measurements showed residual portal perfusion in all studied patients. Early mortality was 10% and the follow up mortality 38.8%. Main causes of death were liver failure and hepatocellular carcinoma. Five and ten years survival rates were 63.9% and 35.1% respectively. The total encephalopathy rate was 12.2%. Rebleeding was observed in 5.5% of the cases and long term shunt patency rate among survivors was 90%. Angiography and sequential scintigraphy showed residual portal perfusion in 75% of cases soon after operation, in 60% after 6 months and 38% after 2 years, showing the tendency of the derivation to diminish the portal perfusion rate in the late postoperative period. The results show that MIS still has a place in the treatment of portal hypertension and that it is an excellent alternative choice to the selective shunts and the devascularization procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Authors

Paquet KJ
No affiliation info available
Mercado MA
No affiliation info available
Kalk JF
No affiliation info available
Koussouris P
No affiliation info available
Siemens F
No affiliation info available
Müting D
No affiliation info available

MeSH

AdolescentAdultAgedAnastomosis, SurgicalBlood PressureEsophageal and Gastric VaricesFemaleGastrointestinal HemorrhageHepatic EncephalopathyHumansHypertension, PortalMaleMesenteric VeinsMiddle AgedPortal VeinProspective StudiesRecurrenceVascular PatencyVena Cava, Inferior

Pub Type(s)

Journal Article

Language

eng

PubMed ID

2631166

Citation

Paquet, K J., et al. "100 Meso-caval Interposition-shunts for Recurrent Variceal Hemorrhage in Portal Hypertension. a Prospective Study." Revista De Investigacion Clinica; Organo Del Hospital De Enfermedades De La Nutricion, vol. 41, no. 4, 1989, pp. 309-17.
Paquet KJ, Mercado MA, Kalk JF, et al. 100 meso-caval interposition-shunts for recurrent variceal hemorrhage in portal hypertension. A prospective study. Rev Invest Clin. 1989;41(4):309-17.
Paquet, K. J., Mercado, M. A., Kalk, J. F., Koussouris, P., Siemens, F., & Müting, D. (1989). 100 meso-caval interposition-shunts for recurrent variceal hemorrhage in portal hypertension. A prospective study. Revista De Investigacion Clinica; Organo Del Hospital De Enfermedades De La Nutricion, 41(4), 309-17.
Paquet KJ, et al. 100 Meso-caval Interposition-shunts for Recurrent Variceal Hemorrhage in Portal Hypertension. a Prospective Study. Rev Invest Clin. 1989 Oct-Dec;41(4):309-17. PubMed PMID: 2631166.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 100 meso-caval interposition-shunts for recurrent variceal hemorrhage in portal hypertension. A prospective study. AU - Paquet,K J, AU - Mercado,M A, AU - Kalk,J F, AU - Koussouris,P, AU - Siemens,F, AU - Müting,D, PY - 1989/10/1/pubmed PY - 1989/10/1/medline PY - 1989/10/1/entrez SP - 309 EP - 17 JF - Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion JO - Rev Invest Clin VL - 41 IS - 4 N2 - The results of a prospective series using the mesocaval interposition shunt (MIS) over a period of 13 years is reviewed: 100 patients were selected for the operation using strict criteria and in 98 cases the operation was performed electively. Selection criteria included liver volume between 1000-2500 mL, portal perfusion between 15-30%, no active liver disease and no stenosis of hepatic artery or coeliac axis as well as a good functional CHILD-PUGH classification (A-B). In all the cases preoperative sclerotherapy was performed so many times as needed by each individual patient with the goal of controlling the active bleeding episodes at admission and of diminishing the pre and postoperative bleeding probability. Intraoperative postshunt measurements showed residual portal perfusion in all studied patients. Early mortality was 10% and the follow up mortality 38.8%. Main causes of death were liver failure and hepatocellular carcinoma. Five and ten years survival rates were 63.9% and 35.1% respectively. The total encephalopathy rate was 12.2%. Rebleeding was observed in 5.5% of the cases and long term shunt patency rate among survivors was 90%. Angiography and sequential scintigraphy showed residual portal perfusion in 75% of cases soon after operation, in 60% after 6 months and 38% after 2 years, showing the tendency of the derivation to diminish the portal perfusion rate in the late postoperative period. The results show that MIS still has a place in the treatment of portal hypertension and that it is an excellent alternative choice to the selective shunts and the devascularization procedures.(ABSTRACT TRUNCATED AT 250 WORDS) SN - 0034-8376 UR - https://www.unboundmedicine.com/medline/citation/2631166/100_meso_caval_interposition_shunts_for_recurrent_variceal_hemorrhage_in_portal_hypertension__A_prospective_study_ DB - PRIME DP - Unbound Medicine ER -