Selective and total shunts in the treatment of bleeding varices. A randomized controlled trial.
Two types of surgical therapy of bleeding esophageal varices were evaluated in 48 patients by a randomized controlled trial: 24 were randomized for a total shunt and 24 for the selective shunt. In two of the latter, a total shunt had to be performed for technical reasons. The fatality rates (six in the 24 total, and six in 22 selective [performed], and seven in 24 selective [randomized]), the frequency of shunt occlusion (two in each group), and of recurrent gastronintestinal bleeding (three in each group) were similar. Encephalopathy developed more often after a total shunt -- 10 of 24, or one per 58 patient-months -- than after selective (performed) -- one of 22, or one per 593 patient-months (P less than 0.005). Total shunts consistently diverted the hepatopetal mesenteric-portal flow from the liver. Deterioration of hepatic function (maximum rate of urea synthesis) was greater after total than selective shunt (P less than 0.05).
D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000150:complications; D001807:Blood Vessel Prosthesis; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control / Q000601:surgery*; D006501:Hepatic Encephalopathy / Q000517:prevention & control; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery; D008099:Liver / Q000378:metabolism; D008102:Liver Circulation; D008297:Male; D008722:Methods; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D012008:Recurrence; D012082:Renal Veins / Q000601:surgery*; D013162:Splenic Vein / Q000601:surgery*; D014508:Urea / Q000096:biosynthesis; D014682:Vena Cava, Inferior / Q000601:surgery*
D014508:Urea