Selective or total shunts for variceal bleeding.
Shunt surgery remains an important therapeutic option in the management of variceal bleeding, and both total and selective shunts have a role to play. The distal shunt is associated with a lower long-term encephalopathy rate and may yield better survival in the nonalcoholic patient; it is, therefore, the preferred shunt in the elective situation. The total shunt is technically easier to perform and more widely available; it is, therefore, preferred in the emergency situation. Ordinarily, the side-to-side and end-to-side shunts have similar outcomes; however, in patients with hepatic venous outflow obstruction and patients with intractable ascites, the side-to-side shunt should be used.
Langer
B
B
Department of Surgery, Toronto General Hospital, Canada.
Taylor
B R
BR
Greig
P D
PD
D004932:Esophageal and Gastric Varices / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006439:Hemodynamics; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D011168:Portal System / Q000503:physiopathology; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects; D012008:Recurrence; D013164:Splenorenal Shunt, Surgical