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[Shunt surgery versus disconnection in portal hypertension. A comparative study].
Rev Esp Enferm Dig. 1996 Apr; 88(4):273-9.RE

Abstract

Controversy remains about the best treatment for patients with esophagogastric variceal bleeding. In spite of different therapeutic alternatives and recent progress, such as liver transplantation of TIPS, many patients will finally be treated by standard surgery. With the aim to know the results of surgery in shunting vs non-shunting procedures, we have analyzed a recent and consecutive series of 68 cirrhotics patients operated on for variceal hemorrhage. According to the surgical technique there were three groups: I) 30 patients underwent a total portacaval shunt; II) 18 cases with an azygosportal disconnection; III) 20 patients with a partial portacaval shunt (8-10 mm H-portacaval PTFE graft). All groups were homogeneous considering age, sex etiology, Child-Pugh grade and timing of surgery (elective vs urgent). The complications and mortality rates were similar for the three groups. The overall operative mortality was 10%, and 5% in selected cases (Child-Pugh A-B, non urgent cases). With a follow-up for I, II and III group of 47, 44 and 27 months respectively, chronic encephalopathy have been seen in 61%, 15% and 15% respectively (p < .05). No patient in group I has rebled, and only one case in the II and III groups had a recurrence of hemorrhage. The actuarial three years survival was 76%, 86% and 85% (p NS), and the five year survival was 41% vs 86% for the groups I and II respectively (p < .05). In conclusion, in selected cases, surgery gives excellent immediate and long term results. In patients with variceal bleeding and failure of first line treatments, such as sclerosis or pharmacology, the partial H-portacaval shunt and non-shunting procedures are good alternatives, with low incidence of rebleeding and chronic encephalopathy.

Authors+Show Affiliations

Servicio de Cirugía Generaly Digestiva, Unidad de Cirugía Hepatobiliar, Hospital Regional, Carlos Haya, Málaga.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
English Abstract
Journal Article

Language

spa

PubMed ID

9004798

Citation

Bondía, J A., et al. "[Shunt Surgery Versus Disconnection in Portal Hypertension. a Comparative Study]." Revista Espanola De Enfermedades Digestivas : Organo Oficial De La Sociedad Espanola De Patologia Digestiva, vol. 88, no. 4, 1996, pp. 273-9.
Bondía JA, Santoyo J, Fernández-Aguilar JL, et al. [Shunt surgery versus disconnection in portal hypertension. A comparative study]. Rev Esp Enferm Dig. 1996;88(4):273-9.
Bondía, J. A., Santoyo, J., Fernández-Aguilar, J. L., Marín, R., Suarez, M. A., Caro, J. A., Jiménez, M., Caparrós, R., Ribeiro, M., & de la Fuente, A. (1996). [Shunt surgery versus disconnection in portal hypertension. A comparative study]. Revista Espanola De Enfermedades Digestivas : Organo Oficial De La Sociedad Espanola De Patologia Digestiva, 88(4), 273-9.
Bondía JA, et al. [Shunt Surgery Versus Disconnection in Portal Hypertension. a Comparative Study]. Rev Esp Enferm Dig. 1996;88(4):273-9. PubMed PMID: 9004798.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Shunt surgery versus disconnection in portal hypertension. A comparative study]. AU - Bondía,J A, AU - Santoyo,J, AU - Fernández-Aguilar,J L, AU - Marín,R, AU - Suarez,M A, AU - Caro,J A, AU - Jiménez,M, AU - Caparrós,R, AU - Ribeiro,M, AU - de la Fuente,A, PY - 1996/4/1/pubmed PY - 1996/4/1/medline PY - 1996/4/1/entrez SP - 273 EP - 9 JF - Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva JO - Rev Esp Enferm Dig VL - 88 IS - 4 N2 - Controversy remains about the best treatment for patients with esophagogastric variceal bleeding. In spite of different therapeutic alternatives and recent progress, such as liver transplantation of TIPS, many patients will finally be treated by standard surgery. With the aim to know the results of surgery in shunting vs non-shunting procedures, we have analyzed a recent and consecutive series of 68 cirrhotics patients operated on for variceal hemorrhage. According to the surgical technique there were three groups: I) 30 patients underwent a total portacaval shunt; II) 18 cases with an azygosportal disconnection; III) 20 patients with a partial portacaval shunt (8-10 mm H-portacaval PTFE graft). All groups were homogeneous considering age, sex etiology, Child-Pugh grade and timing of surgery (elective vs urgent). The complications and mortality rates were similar for the three groups. The overall operative mortality was 10%, and 5% in selected cases (Child-Pugh A-B, non urgent cases). With a follow-up for I, II and III group of 47, 44 and 27 months respectively, chronic encephalopathy have been seen in 61%, 15% and 15% respectively (p < .05). No patient in group I has rebled, and only one case in the II and III groups had a recurrence of hemorrhage. The actuarial three years survival was 76%, 86% and 85% (p NS), and the five year survival was 41% vs 86% for the groups I and II respectively (p < .05). In conclusion, in selected cases, surgery gives excellent immediate and long term results. In patients with variceal bleeding and failure of first line treatments, such as sclerosis or pharmacology, the partial H-portacaval shunt and non-shunting procedures are good alternatives, with low incidence of rebleeding and chronic encephalopathy. SN - 1130-0108 UR - https://www.unboundmedicine.com/medline/citation/9004798/[Shunt_surgery_versus_disconnection_in_portal_hypertension__A_comparative_study]_ L2 - http://www.diseaseinfosearch.org/result/5881 DB - PRIME DP - Unbound Medicine ER -