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[Portosystemic shunts in the treatment of bleeding esophageal varices in cirrhotic patients: between sclerotherapy and transplantation].
Minerva Chir. 1996 Nov; 51(11):887-95.MC

Abstract

In view of the proven efficacy of endoscopic sclerotherapy and the even improving results of liver transplantation, the present role of porto-systemic shunt should be reconsidered. From 1986 (when our liver transplant program began), to March 1994, 59 cirrhotic patients (males = 40, females = 19, mean age 53.17 +/- 12.04) underwent a porto-systemic shunt, 22 under emergency conditions and 37 in an elective setting. Patients were subdivided according to age, emergency or elective surgery, type of operation, and liver function. In the emergency procedures previous sclerotherapy and time between admission and surgery were also considered in the assessment. Mean follow-up was 46.49 +/- 31.48 months. Overall 5-year actuarial survival was 62.5%. In the emergency porto-systemic shunts the worst short-term results were obtained in patients over 55 years of age (p < 0.05) and when operations were performed within the first 24 hours after admission (p < 0.005). Long-term survival was not significantly influenced by the variables considered although patients over 55 years of age and patients with reduced liver function (Child B and C) seemed to have a more dismal outcome. Those patients under 55 years of age, with no portal thrombosis, considered as potential liver transplant candidates, had a better short-term survival rate (p < 0.05) than that of the rest of the patient population studied, mainly because of the better outcome after emergency surgery. Our data confirm the efficacy of porto-systemic shunt procedures in preserving the patient from variceal bleeding. They have a definite role in the complex treatment strategy of portal hypertension, and they must not be considered only a rescue procedure. However, liver transplantation remains the best option to resolve both portal hypertension and the underlying liver disease.

Authors+Show Affiliations

Clinica Chirurgica II, Università degli Studi, Bologna.No 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)

English Abstract
Journal Article

Language

ita

PubMed ID

9072715

Citation

Gozzetti, G, et al. "[Portosystemic Shunts in the Treatment of Bleeding Esophageal Varices in Cirrhotic Patients: Between Sclerotherapy and Transplantation]." Minerva Chirurgica, vol. 51, no. 11, 1996, pp. 887-95.
Gozzetti G, Cavallari A, Mazziotti A, et al. [Portosystemic shunts in the treatment of bleeding esophageal varices in cirrhotic patients: between sclerotherapy and transplantation]. Minerva Chir. 1996;51(11):887-95.
Gozzetti, G., Cavallari, A., Mazziotti, A., Recordare, A., Bellusci, R., Nardo, B., De Raffele, E., Vivarelli, M., & Camillò, B. (1996). [Portosystemic shunts in the treatment of bleeding esophageal varices in cirrhotic patients: between sclerotherapy and transplantation]. Minerva Chirurgica, 51(11), 887-95.
Gozzetti G, et al. [Portosystemic Shunts in the Treatment of Bleeding Esophageal Varices in Cirrhotic Patients: Between Sclerotherapy and Transplantation]. Minerva Chir. 1996;51(11):887-95. PubMed PMID: 9072715.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Portosystemic shunts in the treatment of bleeding esophageal varices in cirrhotic patients: between sclerotherapy and transplantation]. AU - Gozzetti,G, AU - Cavallari,A, AU - Mazziotti,A, AU - Recordare,A, AU - Bellusci,R, AU - Nardo,B, AU - De Raffele,E, AU - Vivarelli,M, AU - Camillò,B, PY - 1996/11/1/pubmed PY - 1996/11/1/medline PY - 1996/11/1/entrez SP - 887 EP - 95 JF - Minerva chirurgica JO - Minerva Chir VL - 51 IS - 11 N2 - In view of the proven efficacy of endoscopic sclerotherapy and the even improving results of liver transplantation, the present role of porto-systemic shunt should be reconsidered. From 1986 (when our liver transplant program began), to March 1994, 59 cirrhotic patients (males = 40, females = 19, mean age 53.17 +/- 12.04) underwent a porto-systemic shunt, 22 under emergency conditions and 37 in an elective setting. Patients were subdivided according to age, emergency or elective surgery, type of operation, and liver function. In the emergency procedures previous sclerotherapy and time between admission and surgery were also considered in the assessment. Mean follow-up was 46.49 +/- 31.48 months. Overall 5-year actuarial survival was 62.5%. In the emergency porto-systemic shunts the worst short-term results were obtained in patients over 55 years of age (p < 0.05) and when operations were performed within the first 24 hours after admission (p < 0.005). Long-term survival was not significantly influenced by the variables considered although patients over 55 years of age and patients with reduced liver function (Child B and C) seemed to have a more dismal outcome. Those patients under 55 years of age, with no portal thrombosis, considered as potential liver transplant candidates, had a better short-term survival rate (p < 0.05) than that of the rest of the patient population studied, mainly because of the better outcome after emergency surgery. Our data confirm the efficacy of porto-systemic shunt procedures in preserving the patient from variceal bleeding. They have a definite role in the complex treatment strategy of portal hypertension, and they must not be considered only a rescue procedure. However, liver transplantation remains the best option to resolve both portal hypertension and the underlying liver disease. SN - 0026-4733 UR - https://www.unboundmedicine.com/medline/citation/9072715/[Portosystemic_shunts_in_the_treatment_of_bleeding_esophageal_varices_in_cirrhotic_patients:_between_sclerotherapy_and_transplantation]_ L2 - http://www.diseaseinfosearch.org/result/2658 DB - PRIME DP - Unbound Medicine ER -