[Clinical results of selective distal splenorenal and latero-lateral portacaval anastomoses. Comparative prospective study of 93 patients].
The distal splenorenal shunt (DSRS) was compared with the side-t-side portacaval shunt (PCS) in 93 prospectively matched cirrhotic patients with portal hypertension. After a mean follow-up of 38 months, no differences were observed in operative mortality, long term survival and variceal rebleeding between the two groups. There was no significant difference in terms of acute encephalopathy (22% in PCS group and 33% in DSRS group) and chronic encephalopathy (35% in PCS and 17% in DSRS). However, the only cases of severe and disabling chronic encephalopathy (CE) arose after PCS (p = 0.049). Actuarial curves of CE showed that the maximum rate of this complication (18%) in the DSRS group was reached 27 months after shunt surgery, whereas this value was reached and passed in PCS group only 4 months after shunt. CE occurred for a total duration of 20.1 months after PCS and only 11.1 months after DSRS (p = 0.003) and occupied 46.3% of the follow-up of PCS patients in contrast to 18.7% of the follow-up of DSRS patients (p = 0.001). DSRS is associated with a lower global incidence of CE without severe forms and provides a better quality of life than does a nonselective shunt.
Pezzuoli
G
G
Università di Milano, Clinica Chirurgica I., Ospedale Policlinico, Italie.
Spina
G P
GP
Galeotti
F
F
Opocher
E
E
Santambrogio
R
R
Gagliano
G
G
Strinna
M
M
D004932:Esophageal and Gastric Varices / Q000517:prevention & control; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000401:mortality; D011446:Prospective Studies; D013164:Splenorenal Shunt, Surgical / Q000401:mortality
Résultats cliniques des anastomoses spléno-rénale distale sélective et porto-cave latéro-latérale. Etude prospective comparée de 93 patients.