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Partial versus total portacaval shunt in alcoholic cirrhosis. Results of a prospective, randomized clinical trial.
Ann Surg. 1994 Apr; 219(4):353-61.AnnS

Abstract

OBJECTIVE

Results of the first prospective randomized clinical trial comparing partial and total portacaval shunt for variceal hemorrhage are reported.

SUMMARY BACKGROUND DATA

Total portacaval shunts produce subnormal portal pressures, completely diverting hepatic portal flow. Partial shunts maintain higher pressures and preserve hepatopedal flow. No randomized trials of these two approaches have been performed.

METHODS

Alcoholic patients with cirrhosis (n = 30) and variceal hemorrhage treated at one institution were randomized to receive partial (8-mm diameter portacaval H grafts with collateral ablation, n = 14) or total shunts (16-mm diameter grafts, n = 16). Portography was performed after operation and then yearly. Investigators blinded to shunt type assessed encephalopathy; hospitalizations were reviewed.

RESULTS

Child's class, age, and operative urgency were similar for the two groups. Two patients (with total shunts) died within 30 days. Hepatopedal flow was maintained in 13 partial and 0 total shunt patients (p < 0.0001). Shunt gradients were 16 +/- 5 compared with 6 +/- 3 cm saline after partial and total shunts (p < 0.0001). There were no shunt thromboses or variceal hemorrhages. Encephalopathy-free survival was significantly greater after partial shunts (p = 0.013; life table analysis). Five total compared with zero partial shunt patients required hospitalization for coma (p = 0.02). Long-term survival was not different for the two groups of patients.

CONCLUSIONS

Partial shunts control variceal hemorrhage while maintaining hepatopedal flow and elevated portal pressures. By minimizing encephalopathy rates, partial shunts provide improved quality of survival compared with total shunts.

Authors+Show Affiliations

Surgical Service, Long Beach Veterans Administration Medical Center, California.No affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

8161260

Citation

Sarfeh, I J., and E B. Rypins. "Partial Versus Total Portacaval Shunt in Alcoholic Cirrhosis. Results of a Prospective, Randomized Clinical Trial." Annals of Surgery, vol. 219, no. 4, 1994, pp. 353-61.
Sarfeh IJ, Rypins EB. Partial versus total portacaval shunt in alcoholic cirrhosis. Results of a prospective, randomized clinical trial. Ann Surg. 1994;219(4):353-61.
Sarfeh, I. J., & Rypins, E. B. (1994). Partial versus total portacaval shunt in alcoholic cirrhosis. Results of a prospective, randomized clinical trial. Annals of Surgery, 219(4), 353-61.
Sarfeh IJ, Rypins EB. Partial Versus Total Portacaval Shunt in Alcoholic Cirrhosis. Results of a Prospective, Randomized Clinical Trial. Ann Surg. 1994;219(4):353-61. PubMed PMID: 8161260.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Partial versus total portacaval shunt in alcoholic cirrhosis. Results of a prospective, randomized clinical trial. AU - Sarfeh,I J, AU - Rypins,E B, PY - 1994/4/1/pubmed PY - 1994/4/1/medline PY - 1994/4/1/entrez SP - 353 EP - 61 JF - Annals of surgery JO - Ann Surg VL - 219 IS - 4 N2 - OBJECTIVE: Results of the first prospective randomized clinical trial comparing partial and total portacaval shunt for variceal hemorrhage are reported. SUMMARY BACKGROUND DATA: Total portacaval shunts produce subnormal portal pressures, completely diverting hepatic portal flow. Partial shunts maintain higher pressures and preserve hepatopedal flow. No randomized trials of these two approaches have been performed. METHODS: Alcoholic patients with cirrhosis (n = 30) and variceal hemorrhage treated at one institution were randomized to receive partial (8-mm diameter portacaval H grafts with collateral ablation, n = 14) or total shunts (16-mm diameter grafts, n = 16). Portography was performed after operation and then yearly. Investigators blinded to shunt type assessed encephalopathy; hospitalizations were reviewed. RESULTS: Child's class, age, and operative urgency were similar for the two groups. Two patients (with total shunts) died within 30 days. Hepatopedal flow was maintained in 13 partial and 0 total shunt patients (p < 0.0001). Shunt gradients were 16 +/- 5 compared with 6 +/- 3 cm saline after partial and total shunts (p < 0.0001). There were no shunt thromboses or variceal hemorrhages. Encephalopathy-free survival was significantly greater after partial shunts (p = 0.013; life table analysis). Five total compared with zero partial shunt patients required hospitalization for coma (p = 0.02). Long-term survival was not different for the two groups of patients. CONCLUSIONS: Partial shunts control variceal hemorrhage while maintaining hepatopedal flow and elevated portal pressures. By minimizing encephalopathy rates, partial shunts provide improved quality of survival compared with total shunts. SN - 0003-4932 UR - https://www.unboundmedicine.com/medline/citation/8161260/Partial_versus_total_portacaval_shunt_in_alcoholic_cirrhosis__Results_of_a_prospective_randomized_clinical_trial_ L2 - https://Insights.ovid.com/pubmed?pmid=8161260 DB - PRIME DP - Unbound Medicine ER -