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Role of distal splenorenal shunt for long-term management of variceal bleeding.
World J Surg. 1994 Mar-Apr; 18(2):205-10.WJ

Abstract

Distal splenorenal shunt (DSRS) has been studied extensively over the past 25 years to define its role in management of variceal bleeding. The operative technique of the shunt has not changed, but more aggressive attempts at portal-azygos disconnection have been studied for their effect on maintenance of portal perfusion. Control of variceal bleeding is achieved in about 90% of patients. Portal flow to the liver is maintained in > 90% of patients with nonalcoholic etiology of portal hypertension and in 50% to 84% of patients with alcoholic cirrhosis depending on the degree of portal-azygos disconnection. Encephalopathy and liver failure do not seem to be accelerated by DSRS but depend on the severity of the underlying liver disease. Reported survival likewise depends on the etiology of portal hypertension and the severity of liver disease: > 90% survival can be achieved in portal vein thrombosis and patients with cirrhosis and normal liver function, but 50% to 60% 3- to 5-year survivals are reported for patients with more advanced disease. DSRS offers one treatment modality for management of variceal bleeding that must fit into an overall strategy for these patients. Full evaluation is the key to allow selection of patients for pharmacotherapy, sclerotherapy, variceal decompression, or liver transplantation.

Authors+Show Affiliations

Department of General Surgery, Cleveland Clinic Foundation, Ohio 44195.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

8042324

Citation

Henderson, J M.. "Role of Distal Splenorenal Shunt for Long-term Management of Variceal Bleeding." World Journal of Surgery, vol. 18, no. 2, 1994, pp. 205-10.
Henderson JM. Role of distal splenorenal shunt for long-term management of variceal bleeding. World J Surg. 1994;18(2):205-10.
Henderson, J. M. (1994). Role of distal splenorenal shunt for long-term management of variceal bleeding. World Journal of Surgery, 18(2), 205-10.
Henderson JM. Role of Distal Splenorenal Shunt for Long-term Management of Variceal Bleeding. World J Surg. 1994 Mar-Apr;18(2):205-10. PubMed PMID: 8042324.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of distal splenorenal shunt for long-term management of variceal bleeding. A1 - Henderson,J M, PY - 1994/3/1/pubmed PY - 1994/3/1/medline PY - 1994/3/1/entrez SP - 205 EP - 10 JF - World journal of surgery JO - World J Surg VL - 18 IS - 2 N2 - Distal splenorenal shunt (DSRS) has been studied extensively over the past 25 years to define its role in management of variceal bleeding. The operative technique of the shunt has not changed, but more aggressive attempts at portal-azygos disconnection have been studied for their effect on maintenance of portal perfusion. Control of variceal bleeding is achieved in about 90% of patients. Portal flow to the liver is maintained in > 90% of patients with nonalcoholic etiology of portal hypertension and in 50% to 84% of patients with alcoholic cirrhosis depending on the degree of portal-azygos disconnection. Encephalopathy and liver failure do not seem to be accelerated by DSRS but depend on the severity of the underlying liver disease. Reported survival likewise depends on the etiology of portal hypertension and the severity of liver disease: > 90% survival can be achieved in portal vein thrombosis and patients with cirrhosis and normal liver function, but 50% to 60% 3- to 5-year survivals are reported for patients with more advanced disease. DSRS offers one treatment modality for management of variceal bleeding that must fit into an overall strategy for these patients. Full evaluation is the key to allow selection of patients for pharmacotherapy, sclerotherapy, variceal decompression, or liver transplantation. SN - 0364-2313 UR - https://www.unboundmedicine.com/medline/citation/8042324/Role_of_distal_splenorenal_shunt_for_long_term_management_of_variceal_bleeding_ L2 - https://medlineplus.gov/gastrointestinalbleeding.html DB - PRIME DP - Unbound Medicine ER -