Tags

Type your tag names separated by a space and hit enter

Distal splenorenal shunt with splenopancreatic disconnection. A 4-year assessment.
Ann Surg. 1989 Sep; 210(3):332-9; discussion 339-41.AnnS

Abstract

The aims of distal splenorenal shunt with splenopancreatic disconnection (DSRS-SPD) were to improve maintenance of portal flow and prevent siphoning of hepatotrophic factors from the pancreas, as occurs after standard DSRS. The main patient population targeted for improvement were alcoholic cirrhotics, who have poorer survival than nonalcoholic cirrhotics and greater loss of portal flow (60%) after standard DSRS. Seventy-eight patients had DSRS-SPD during the study period 1983 to 1987: thirty-two patients were Child's A, 25 were Child's B, and 21 were Child's C. The 35 patients with alcoholic cirrhosis were a significantly poorer risk group by Child's class and galactose elimination capacity (GEC) than the 39 patients with nonalcoholic cirrhosis. Four patients had portal vein thrombosis. At 4-year follow-up, portal perfusion is maintained in 84% alcoholic and 90% nonalcoholic patients, with hepatic and systemic hemodynamics showing identical patterns for both groups. Hepatic function measured by GEC was maintained in alcoholic patients (290 +/- 68 mg/min to 303 +/- 74 mg/min) and nonalcoholics patients (342 +/- 92 to 320 +/- 118 mg/min). Gastric variceal rebleeding occurred in 10 patients--4 early (less than 2 months) and 6 late (18 to 54 months), leading to operation in 4 and transhepatic embolization in 4 patients: 2 of these patients died from this complication. Survival data show an operative mortality rate of 6.4% and overall mortality rate of 30%, with no significant difference between alcoholic and nonalcoholic cirrhotics. DSRS-SPD has significantly improved maintenance of portal perfusion and survival in patients with alcoholic cirrhosis requiring selective shunt for variceal bleeding when compared to standard DSRS. In this population DSRS-SPD is the operation of choice. In patients with nonalcoholic cirrhosis, the current data have not shown DSRS-SPD to have advantage over standard DSRS.

Authors+Show Affiliations

Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

2789022

Citation

Henderson, J M., et al. "Distal Splenorenal Shunt With Splenopancreatic Disconnection. a 4-year Assessment." Annals of Surgery, vol. 210, no. 3, 1989, pp. 332-9; discussion 339-41.
Henderson JM, Warren WD, Millikan WJ, et al. Distal splenorenal shunt with splenopancreatic disconnection. A 4-year assessment. Ann Surg. 1989;210(3):332-9; discussion 339-41.
Henderson, J. M., Warren, W. D., Millikan, W. J., Galloway, J. R., Kawasaki, S., & Kutner, M. H. (1989). Distal splenorenal shunt with splenopancreatic disconnection. A 4-year assessment. Annals of Surgery, 210(3), 332-9; discussion 339-41.
Henderson JM, et al. Distal Splenorenal Shunt With Splenopancreatic Disconnection. a 4-year Assessment. Ann Surg. 1989;210(3):332-9; discussion 339-41. PubMed PMID: 2789022.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Distal splenorenal shunt with splenopancreatic disconnection. A 4-year assessment. AU - Henderson,J M, AU - Warren,W D, AU - Millikan,W J, AU - Galloway,J R, AU - Kawasaki,S, AU - Kutner,M H, PY - 1989/9/1/pubmed PY - 1989/9/1/medline PY - 1989/9/1/entrez SP - 332-9; discussion 339-41 JF - Annals of surgery JO - Ann Surg VL - 210 IS - 3 N2 - The aims of distal splenorenal shunt with splenopancreatic disconnection (DSRS-SPD) were to improve maintenance of portal flow and prevent siphoning of hepatotrophic factors from the pancreas, as occurs after standard DSRS. The main patient population targeted for improvement were alcoholic cirrhotics, who have poorer survival than nonalcoholic cirrhotics and greater loss of portal flow (60%) after standard DSRS. Seventy-eight patients had DSRS-SPD during the study period 1983 to 1987: thirty-two patients were Child's A, 25 were Child's B, and 21 were Child's C. The 35 patients with alcoholic cirrhosis were a significantly poorer risk group by Child's class and galactose elimination capacity (GEC) than the 39 patients with nonalcoholic cirrhosis. Four patients had portal vein thrombosis. At 4-year follow-up, portal perfusion is maintained in 84% alcoholic and 90% nonalcoholic patients, with hepatic and systemic hemodynamics showing identical patterns for both groups. Hepatic function measured by GEC was maintained in alcoholic patients (290 +/- 68 mg/min to 303 +/- 74 mg/min) and nonalcoholics patients (342 +/- 92 to 320 +/- 118 mg/min). Gastric variceal rebleeding occurred in 10 patients--4 early (less than 2 months) and 6 late (18 to 54 months), leading to operation in 4 and transhepatic embolization in 4 patients: 2 of these patients died from this complication. Survival data show an operative mortality rate of 6.4% and overall mortality rate of 30%, with no significant difference between alcoholic and nonalcoholic cirrhotics. DSRS-SPD has significantly improved maintenance of portal perfusion and survival in patients with alcoholic cirrhosis requiring selective shunt for variceal bleeding when compared to standard DSRS. In this population DSRS-SPD is the operation of choice. In patients with nonalcoholic cirrhosis, the current data have not shown DSRS-SPD to have advantage over standard DSRS. SN - 0003-4932 UR - https://www.unboundmedicine.com/medline/citation/2789022/Distal_splenorenal_shunt_with_splenopancreatic_disconnection__A_4_year_assessment_ L2 - https://journals.lww.com/2789022.pmid DB - PRIME DP - Unbound Medicine ER -