[The fate of Warren's splenorenal shunt in the era of sclerotherapy].
From 1969 to 1990, 52 patients underwent splenorenal shunt after one or more esophageal variceal hemorrhages. Sixty days' mortality was 15.4% (8 deaths). 3 patients were lost to follow-up soon after hospital discharge. The remaining 41 patients could be followed for 5.5 years on average: 26 died, 3 were lost to follow-up late after discharge and 12 are presently alive. Only 4 of the followed-up patients suffered recurrent bleeding due to a thrombosed shunt. Temporary mental disturbances were noted in 4 cases but no incapacitating encephalopathy was recorded. In the last 10 years, performance of the Warren shunt has decreased strikingly as a result of the increasing popularity of endoscopic sclerotherapy. Surgical and anesthetic techniques have, however, improved too, resulting in a lower morbidity and mortality rate. Recurrent bleeding and neurological sequelae being rare, we conclude that distal splenorenal shunt remains a valuable alternative to long-term sclerotherapy in selected cases.
Cuénoud
P F
PF
Service de chirurgie B, CHUV, Lausanne.
Crivelli
N
N
Broennimann
B
B
Mosimann
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000601:surgery* / Q000628:therapy; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008875:Middle Aged; D015911:Sclerotherapy; D013164:Splenorenal Shunt, Surgical / Q000379:methods* / Q000401:mortality
Devenir du shunt splénorénal distal selon Warren à l'ére de la sclérothérapie.