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Ten years of experience with patients with chronic active liver disease variceal bleeding: ablative versus selective decompressive therapy.
Surgery. 1993 Nov; 114(5):868-81.S

Abstract

BACKGROUND

Variceal hemorrhage is an added major threat to survival in patients with chronic active liver disease (CALD). The hemodynamic consequences of surgical therapy and the continued activity of the underlying liver disease both contribute to the hepatic dysfunction and determine patient survival.

METHODS

Two hundred and seventy two consecutive cases of (Child A or B) variceal bleeding with chronic hepatitis were surgically treated during a 10-year period. Histologic chronic active hepatitis (CAH) was documented in 160 (59%) patients, whereas chronic persistent hepatitis (CPH) was evident in 112 (41%). The applied surgical procedure was distal splenorenal shunt (DSRS) in 99 (36%) patients, splenectomy and gastroesophageal devascularization (SGD) in 108 (40%), and splenectomy with left gastric ligation (SLGL) in 65 (24%) patients. The preoperative data base obtained on these patients was matched comparing the three surgical modalities within each pathologic group (p > 0.05).

RESULTS

The operative mortality was low among the patients with CAH (DSRS, 5.1%; SGD, 4.2%) with no deaths occurring in the CPH group. Among the individuals with CAH, recurrent variceal hemorrhage occurred significantly (p < 0.05) more often after SLGL (26%) and SGD (17%) than after DSRS (5%). Sclerotherapy rescued 93% (SGD) and 70% (SLGL) of the patients with rebleeding. DSRS significantly (p < 0.05) increased the risk of encephalopathy (28%) compared with SGD (4.2%) and SLGL (8%). The morbidity rates were quite low among the patients with CPH with no significant (p > 0.05) differences noted when the three surgical modalities were compared. Both groups experienced a significant (p < 0.05) increase in aspartate aminotransferase levels after the three procedures with a significant (p < 0.05) increase in bilirubin level occurring only after DSRS. The 5-year survival rate for the patients with variceal bleeding with CAH was 76% (DSRS), 73% (SGD), and 88% (SLGL). The leading causes of death were liver failure after DSRS (70%), variceal hemorrhage after SLGL (60%), and equally divided between septicemia (43%) and liver failure (43%) after SGD. The patients with CPH had a better 5-year survival of 89% (DSRS) and 100% (nonshunt operation).

CONCLUSIONS

These data showed that (1) CALD is common among cases of variceal bleeding; (2) elective surgical treatment of variceal hemorrhage in patients with Child A or B CALD has a low operative mortality; (3) SLGL backed up by sclerotherapy is a better surgical alternative to either selective shunt or SGD in patients with active hepatitis, and (4) both DSRS and nonshunt operation are equally good surgical options for patients with CPH.

Authors+Show Affiliations

Department of Surgery, Mansoura University School of Medicine, Egypt.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

8236008

Citation

Abu-Elmagd, K M., et al. "Ten Years of Experience With Patients With Chronic Active Liver Disease Variceal Bleeding: Ablative Versus Selective Decompressive Therapy." Surgery, vol. 114, no. 5, 1993, pp. 868-81.
Abu-Elmagd KM, Aly MA, Fathy OM, et al. Ten years of experience with patients with chronic active liver disease variceal bleeding: ablative versus selective decompressive therapy. Surgery. 1993;114(5):868-81.
Abu-Elmagd, K. M., Aly, M. A., Fathy, O. M., E-Ghawlby, N. A., el-Fiky, A. M., el-Barbary, M. H., el-Hak, N. G., el-Ebady, G. E., Sultan, A., & Bahgat, O. O. (1993). Ten years of experience with patients with chronic active liver disease variceal bleeding: ablative versus selective decompressive therapy. Surgery, 114(5), 868-81.
Abu-Elmagd KM, et al. Ten Years of Experience With Patients With Chronic Active Liver Disease Variceal Bleeding: Ablative Versus Selective Decompressive Therapy. Surgery. 1993;114(5):868-81. PubMed PMID: 8236008.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ten years of experience with patients with chronic active liver disease variceal bleeding: ablative versus selective decompressive therapy. A1 - Abu-Elmagd,K M, AU - Aly,M A, AU - Fathy,O M, AU - E-Ghawlby,N A, AU - el-Fiky,A M, AU - el-Barbary,M H, AU - el-Hak,N G, AU - el-Ebady,G E, AU - Sultan,A, AU - Bahgat,O O, PY - 1993/11/1/pubmed PY - 1993/11/1/medline PY - 1993/11/1/entrez SP - 868 EP - 81 JF - Surgery JO - Surgery VL - 114 IS - 5 N2 - BACKGROUND: Variceal hemorrhage is an added major threat to survival in patients with chronic active liver disease (CALD). The hemodynamic consequences of surgical therapy and the continued activity of the underlying liver disease both contribute to the hepatic dysfunction and determine patient survival. METHODS: Two hundred and seventy two consecutive cases of (Child A or B) variceal bleeding with chronic hepatitis were surgically treated during a 10-year period. Histologic chronic active hepatitis (CAH) was documented in 160 (59%) patients, whereas chronic persistent hepatitis (CPH) was evident in 112 (41%). The applied surgical procedure was distal splenorenal shunt (DSRS) in 99 (36%) patients, splenectomy and gastroesophageal devascularization (SGD) in 108 (40%), and splenectomy with left gastric ligation (SLGL) in 65 (24%) patients. The preoperative data base obtained on these patients was matched comparing the three surgical modalities within each pathologic group (p > 0.05). RESULTS: The operative mortality was low among the patients with CAH (DSRS, 5.1%; SGD, 4.2%) with no deaths occurring in the CPH group. Among the individuals with CAH, recurrent variceal hemorrhage occurred significantly (p < 0.05) more often after SLGL (26%) and SGD (17%) than after DSRS (5%). Sclerotherapy rescued 93% (SGD) and 70% (SLGL) of the patients with rebleeding. DSRS significantly (p < 0.05) increased the risk of encephalopathy (28%) compared with SGD (4.2%) and SLGL (8%). The morbidity rates were quite low among the patients with CPH with no significant (p > 0.05) differences noted when the three surgical modalities were compared. Both groups experienced a significant (p < 0.05) increase in aspartate aminotransferase levels after the three procedures with a significant (p < 0.05) increase in bilirubin level occurring only after DSRS. The 5-year survival rate for the patients with variceal bleeding with CAH was 76% (DSRS), 73% (SGD), and 88% (SLGL). The leading causes of death were liver failure after DSRS (70%), variceal hemorrhage after SLGL (60%), and equally divided between septicemia (43%) and liver failure (43%) after SGD. The patients with CPH had a better 5-year survival of 89% (DSRS) and 100% (nonshunt operation). CONCLUSIONS: These data showed that (1) CALD is common among cases of variceal bleeding; (2) elective surgical treatment of variceal hemorrhage in patients with Child A or B CALD has a low operative mortality; (3) SLGL backed up by sclerotherapy is a better surgical alternative to either selective shunt or SGD in patients with active hepatitis, and (4) both DSRS and nonshunt operation are equally good surgical options for patients with CPH. SN - 0039-6060 UR - https://www.unboundmedicine.com/medline/citation/8236008/Ten_years_of_experience_with_patients_with_chronic_active_liver_disease_variceal_bleeding:_ablative_versus_selective_decompressive_therapy_ L2 - http://www.diseaseinfosearch.org/result/7025 DB - PRIME DP - Unbound Medicine ER -