[Distal splenorenal shunt without deconnection in the prevention of recurrent digestive hemorrhage in the cirrhotic patient].
The emergent treatment of gastrointestinal hemorrhage caused by the rupture of esophageal varices in cirrhotic patients is based on sclerotherapy. The prevention of frequent recurrence may be an indication of portocaval shunting. Over an 8-year period, 72 patients were operated with a distal splenorenal shunt without deconnection aimed at preventing gastrointestinal rebleeding. This was non-emergent surgery. The Child-Pugh grade was 41 A and 31 B. All patients had an angiography, which demonstrated the lack of arterioportal reflux. Operative mortality was 2.7%. Actuarial survival at 5 years was of 67%, respectively 71% for grade A and 60% for grade B. Patency of the shunt was estimated to be 90%. Persistence of hepatopetal flow on control arteriography has been established in 65% of cases. Rebleeding was observed in 10% of cases, and episodes of encephalopathy in 10% as well out of 60 studied cases, 29 presented with a chronic increase in ammoniemia (48%). Two risk factors of mortality have been demonstrated: age higher than 60 years, and relapse of ethylic intoxication, which has been observed in 40% of cases. Later hepatic transplantation has been performed in one case, without success. These results are similar to those obtained with Warren's procedure. Further development of hepatic transplantation may limit its indications.
Quandalle
P
P
Service de Chirurgie Adultes Ouest, C.H.R.U., Lille.
Rossi
S
S
Paris
J C
JC
Chambon
J P
JP
Lescut
J
J
Gamblin
C
C
Saudemont
A
A
Ribet
M
M
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015911:Sclerotherapy; D013164:Splenorenal Shunt, Surgical / Q000379:methods / Q000401:mortality; D015996:Survival Rate; D017211:Treatment Failure
La dérivation spléno-rénale distale sans déconnexion dans la prévention des récidives d'hémorragie digestive chez le cirrhothique.