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[Narrow-lumen mesocaval interposition shunt in liver cirrhosis and recurrent esophageal varices hemorrhage. Standard surgery of the future in failure of sclerotherapy?].
Dtsch Med Wochenschr. 1995 May 19; 120(20):707-12.DM

Abstract

In a prospective study, conducted between 1.1.1987 and 31.12.1992, 72 consecutive patients (50 men, 22 women; mean age 59.8 [16-72] years) with cirrhosis of the liver and recurrent bleeding from oesophageal or fundal varices, were treated with a mesocaval interposition shunt, made of reinforced Goretex 10 or 12 mm in diameter. Further selection criteria were Child-Pugh class A (n = 39) or B (n = 33), liver volume (by ultrasound) between 1000 and 2500 ml, portal vein perfusion index of at least 10% and histological exclusion of activity or progression of the cirrhosis. Four patients (5.6%) died during the first 30 days after the intervention, and four had recurrent bleeding from the varices, three of them during the postoperative period, one during the second postoperative year. The cumulative shunt patency rate was 94.4% (up to 84 months). An acute encephalopathy occurred in six patients (8.3%), which was successfully treated with protein restriction and neomycin administration. Intra- and post-operative hemodynamic investigation confirmed maintenance of portal-vein perfusion in all patients, but there was a significant tendency towards reduction after 3 years in all patients. The overall survival rate after 7 years was 75%, with 85% for patients in Child-Pugh class A and 65% for those in class B. The results indicate that the described method can achieve satisfactory portal decompression with maintenance of portal-vein flow. It is especially suitable as a standard method if sclerotherapy has failed.

Authors+Show Affiliations

Department für Chirurgie, Heinz-Kalk-Krankenhaus, Bad Kissingen.No affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

ger

PubMed ID

7758409

Citation

Paquet, K J., et al. "[Narrow-lumen Mesocaval Interposition Shunt in Liver Cirrhosis and Recurrent Esophageal Varices Hemorrhage. Standard Surgery of the Future in Failure of Sclerotherapy?]." Deutsche Medizinische Wochenschrift (1946), vol. 120, no. 20, 1995, pp. 707-12.
Paquet KJ, Lazar A, Kuhn R. [Narrow-lumen mesocaval interposition shunt in liver cirrhosis and recurrent esophageal varices hemorrhage. Standard surgery of the future in failure of sclerotherapy?]. Dtsch Med Wochenschr. 1995;120(20):707-12.
Paquet, K. J., Lazar, A., & Kuhn, R. (1995). [Narrow-lumen mesocaval interposition shunt in liver cirrhosis and recurrent esophageal varices hemorrhage. Standard surgery of the future in failure of sclerotherapy?]. Deutsche Medizinische Wochenschrift (1946), 120(20), 707-12.
Paquet KJ, Lazar A, Kuhn R. [Narrow-lumen Mesocaval Interposition Shunt in Liver Cirrhosis and Recurrent Esophageal Varices Hemorrhage. Standard Surgery of the Future in Failure of Sclerotherapy?]. Dtsch Med Wochenschr. 1995 May 19;120(20):707-12. PubMed PMID: 7758409.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Narrow-lumen mesocaval interposition shunt in liver cirrhosis and recurrent esophageal varices hemorrhage. Standard surgery of the future in failure of sclerotherapy?]. AU - Paquet,K J, AU - Lazar,A, AU - Kuhn,R, PY - 1995/5/19/pubmed PY - 1995/5/19/medline PY - 1995/5/19/entrez SP - 707 EP - 12 JF - Deutsche medizinische Wochenschrift (1946) JO - Dtsch Med Wochenschr VL - 120 IS - 20 N2 - In a prospective study, conducted between 1.1.1987 and 31.12.1992, 72 consecutive patients (50 men, 22 women; mean age 59.8 [16-72] years) with cirrhosis of the liver and recurrent bleeding from oesophageal or fundal varices, were treated with a mesocaval interposition shunt, made of reinforced Goretex 10 or 12 mm in diameter. Further selection criteria were Child-Pugh class A (n = 39) or B (n = 33), liver volume (by ultrasound) between 1000 and 2500 ml, portal vein perfusion index of at least 10% and histological exclusion of activity or progression of the cirrhosis. Four patients (5.6%) died during the first 30 days after the intervention, and four had recurrent bleeding from the varices, three of them during the postoperative period, one during the second postoperative year. The cumulative shunt patency rate was 94.4% (up to 84 months). An acute encephalopathy occurred in six patients (8.3%), which was successfully treated with protein restriction and neomycin administration. Intra- and post-operative hemodynamic investigation confirmed maintenance of portal-vein perfusion in all patients, but there was a significant tendency towards reduction after 3 years in all patients. The overall survival rate after 7 years was 75%, with 85% for patients in Child-Pugh class A and 65% for those in class B. The results indicate that the described method can achieve satisfactory portal decompression with maintenance of portal-vein flow. It is especially suitable as a standard method if sclerotherapy has failed. SN - 0012-0472 UR - https://www.unboundmedicine.com/medline/citation/7758409/[Narrow_lumen_mesocaval_interposition_shunt_in_liver_cirrhosis_and_recurrent_esophageal_varices_hemorrhage__Standard_surgery_of_the_future_in_failure_of_sclerotherapy]_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2008-1055398 DB - PRIME DP - Unbound Medicine ER -