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Distal splenorenal shunt for management of variceal bleeding in patients with schistosomal hepatic fibrosis.
Ann Surg. 1986 Nov; 204(5):566-73.AnnS

Abstract

The distal splenorenal shunt was performed in 60 patients with schistosomal hepatic fibrosis in whom no evidence of cirrhosis was documented by preoperative needle and operative wedge biopsy. No patients have been lost to follow-up with a median of 37 months (range: 17-86). The results showed low operative mortality (1.7%), high patency rate (92.5%), and low recurrent variceal hemorrhage (6.7%). Thrombosed shunts were treated either by refashioning the shunt (1 patient) or splenectomy and gastric devascularization (2 patients). Initial hyperbilirubinemia and reduction in serum albumin were found in the early postoperative period, with persistent hyperbilirubinemia in 32% of the patients. The 5-year survival was 88%, with liver disease related mortality in only three patients. Clinical encephalopathy was detected in three patients (5.1%); only one of them was incapacitated. These data showed that: selective shunt (distal splenorenal shunt, DSRS) is an effective surgical procedure in the treatment of schistosomal variceal bleeding, shunt thrombosis is rare and can possible be corrected if detected early, schistosomal patients have a better survival and a lower incidence of encephalopathy after DSRS than that reported in cirrhotics, and liver biopsy should be performed for proper assessment of the schistosomal population especially in the geographic areas where the schistosoma parasite and viral hepatitis are endemic.

Authors

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Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

3767488

Citation

Ezzat, F A., et al. "Distal Splenorenal Shunt for Management of Variceal Bleeding in Patients With Schistosomal Hepatic Fibrosis." Annals of Surgery, vol. 204, no. 5, 1986, pp. 566-73.
Ezzat FA, Abu-Elmagd KM, Aly IY, et al. Distal splenorenal shunt for management of variceal bleeding in patients with schistosomal hepatic fibrosis. Ann Surg. 1986;204(5):566-73.
Ezzat, F. A., Abu-Elmagd, K. M., Aly, I. Y., Aly, M. A., Fathy, O. M., el-Barbary, M. H., Bahgat, O. O., Salam, A. A., & Kutner, M. H. (1986). Distal splenorenal shunt for management of variceal bleeding in patients with schistosomal hepatic fibrosis. Annals of Surgery, 204(5), 566-73.
Ezzat FA, et al. Distal Splenorenal Shunt for Management of Variceal Bleeding in Patients With Schistosomal Hepatic Fibrosis. Ann Surg. 1986;204(5):566-73. PubMed PMID: 3767488.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Distal splenorenal shunt for management of variceal bleeding in patients with schistosomal hepatic fibrosis. AU - Ezzat,F A, AU - Abu-Elmagd,K M, AU - Aly,I Y, AU - Aly,M A, AU - Fathy,O M, AU - el-Barbary,M H, AU - Bahgat,O O, AU - Salam,A A, AU - Kutner,M H, PY - 1986/11/1/pubmed PY - 1986/11/1/medline PY - 1986/11/1/entrez SP - 566 EP - 73 JF - Annals of surgery JO - Ann. Surg. VL - 204 IS - 5 N2 - The distal splenorenal shunt was performed in 60 patients with schistosomal hepatic fibrosis in whom no evidence of cirrhosis was documented by preoperative needle and operative wedge biopsy. No patients have been lost to follow-up with a median of 37 months (range: 17-86). The results showed low operative mortality (1.7%), high patency rate (92.5%), and low recurrent variceal hemorrhage (6.7%). Thrombosed shunts were treated either by refashioning the shunt (1 patient) or splenectomy and gastric devascularization (2 patients). Initial hyperbilirubinemia and reduction in serum albumin were found in the early postoperative period, with persistent hyperbilirubinemia in 32% of the patients. The 5-year survival was 88%, with liver disease related mortality in only three patients. Clinical encephalopathy was detected in three patients (5.1%); only one of them was incapacitated. These data showed that: selective shunt (distal splenorenal shunt, DSRS) is an effective surgical procedure in the treatment of schistosomal variceal bleeding, shunt thrombosis is rare and can possible be corrected if detected early, schistosomal patients have a better survival and a lower incidence of encephalopathy after DSRS than that reported in cirrhotics, and liver biopsy should be performed for proper assessment of the schistosomal population especially in the geographic areas where the schistosoma parasite and viral hepatitis are endemic. SN - 0003-4932 UR - https://www.unboundmedicine.com/medline/citation/3767488/Distal_splenorenal_shunt_for_management_of_variceal_bleeding_in_patients_with_schistosomal_hepatic_fibrosis_ L2 - http://Insights.ovid.com/pubmed?pmid=3767488 DB - PRIME DP - Unbound Medicine ER -