Analysis of a prospective series of 100 mesocaval interposition shunts for bleeding portal hypertension.
The results of a prospective series using the mesocaval interposition shunt (MIS) over a period of 13 years is reviewed. One hundred patients were selected for the operation using strict criteria, and in 98 cases the operation was performed electively. Selection criteria included a liver volume of between 1,000 and 2,500 ml, portal perfusion of between 15-30%, no active liver disease and no stenosis of hepatic artery or celiac axis, as well as a good functional Child-Pugh classification (A-B). In all the cases preoperative sclerotherapy was performed as many times as needed with the aim of controlling the active bleeding at admission and of diminishing the pre- and postoperative bleeding probability. Intra-operative postshunt measurements showed residual portal perfusion in all patients studied. Early mortality was 10% and the follow-up mortality 38.8%. The main causes of death were liver failure and hepatocellular carcinoma. The five- and ten-year survival rates were 65% and 35%, respectively. The total encephalopathy rate was 12.2%. Rebleeding was observed in 5.5% of the cases, and the long term-shunt patency rate was 90%. Anigography and sequential scintigraphy showed residual portal perfusion in 75% of the cases soon after operation, in 60% after 6 months, and in 38% after 2 years, showing the tendency of the diversion to diminish the portal perfusion rate in the late postoperative period. The results show that MIS still has a place in the treatment of portal hypertension and that it is an excellent alternative choice to the selective shunts and the devasculariaztion procedures.(ABSTRACT TRUNCATED AT 250 WORDS)
Paquet
K J
KJ
Department of Surgery and Medicine, Heinz-Kalk-Hospital, Bad Kissingen, W.-Germany.
Mercado
M A
MA
Kalk
J F
JF
Koussouris
P
P
Siemens
F
F
Müting
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects; D011446:Prospective Studies