title: Elective management of the patient who has bled from esophageal varices.
abstract: Variceal hemorrhage can be controlled by nonsurgical means in over 50% of patients. As a result, their general hepatic status can often be improved by preoperative preparation for the elective procedure. The major problem following elective end-to-side portacaval shunting is encephalopathy; it occurs in up to one half of patients who undergo this shunting procedure. Mesocaval shunting has been proposed as a better operation because of lower frequency of encephalopathy; however, the authors' experience has not confirmed this. Distal splenorenal shunting, as shown by the results of a prospective controlled trial, does have a lower frequency of encephalopathy, but the initial morbidity and mortality are higher and an improvement in the duration of survival is not yet evident.
mesh_terms: D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000601:surgery*; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000601:surgery*; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D008102:Liver Circulation; D008642:Mesenteric Veins / Q000601:surgery; D008722:Methods; D011167:Portacaval Shunt, Surgical; D011183:Postoperative Complications; D012082:Renal Veins / Q000601:surgery; D013162:Splenic Vein / Q000601:surgery; D014684:Venae Cavae / Q000601:surgery