[Calibrated latero-lateral portacaval anastomosis in the treatment of digestive hemorrhages by portal hypertension in the cirrhotic patient].
The calibrated side to side portocaval shunt was described in 1979 by P. Marion. This type of shunt preserves a hepatopedal blood flow by maintaining portocaval pressure gradient superior to halve of the initial gradient. Twenty nine shunts were performed from 1981 to 1989 in patients with hemorrhagic liver cirrhosis alcoholic in 83 percent of cases). Two patients were in Child Pugh C class (7%), six procedures were performed as an emergency (21%). The operative mortality was nil. The hepatopedal blood flow assessed by direct venous angiography was maintained in 66% of cases at one year and 22% at five years. The actuarial survival rate without recurrent bleeding was 96% at two years, 88% at five years. Severe chronic encephalopathy was noted in three cases (10.3%). One patient was successfully treated by surgical anastomotic tightening with disappearance of the hepatic encephalopathy. The actuarial survival rate without encephalopathy was 82.7% at five years. The side to side calibrated shunt is a technically easy procedure with low mortality, low incidence of thrombosis and clinical results similar to the results of Warren's procedure. For these reasons, we have decided to include this procedure in our local protocol of management of hemorrhagic liver cirrhosis.
Segol
P
P
Service de Chirurgie Digestive, CHU Côte de Nacre, Caen.
Auvray
S
S
Dao
T
T
Apoil
B
B
Justum
A M
AM
Deshayes
J P
JP
Launoy
G
G
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008103:Liver Cirrhosis / Q000150:complications*; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D011859:Radiography; D012008:Recurrence
L'anastomose porto-cave latéro-latérale calibrée dans le traitement des hémorragies digestives par hypertension portale du cirrhotique.