Long-term follow-up of poor-risk patients undergoing small-diameter portacaval shunts.
The small-diameter portacaval H-graft has been shown to be a reliable method of controlling variceal hemorrhage. However, little has been written about the long-term follow-up of poor-risk patients treated by this method. Over the last 11 years, we have performed 38 portacaval H-grafts; 79% of the patients were Child's B or C, and 79% were alcoholic. The mean age was 52 years, and the mean period of follow-up was 44 months. Over 37% of the grafts were performed in patients who were bleeding at the time of operation. Our 30-day operative mortality was 13%. Postoperatively, the small-diameter H-graft was associated with mild to moderate encephalopathy in 33% of the patients and ascites in 42%. Both these conditions were easily controlled with diet and medication. Early recurrent variceal bleeding was seen in 13% of patients. However, on late follow-up, recurrent hemorrhage and encephalopathy have been seen in only 12% and 14% of patients, respectively. We conclude that the portacaval H-graft is a reliable and lasting method for controlling variceal bleeding with an acceptable postoperative morbidity and mortality.
Darling
R C
RC
Department of Surgery, Albany Medical College, New York 12208.
Shah
D M
DM
Chang
B B
BB
Thompson
P N
PN
Leather
R P
RP
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors