title: Selective shunts: the Johannesburg experience.
abstract: My personal 15-year experience with 141 selective shunts (127 elective, 14 emergency) for portal hypertension is reported. Alcoholic cirrhosis comprised 54% of elective operations, and of the nonalcoholic patients, 22% were cirrhotic and 24% were noncirrhotic. Adequate and, if necessary, prolonged (mean 6 weeks) in-hospital preparation resulted in Hospital mortality and long-term actuarial survival were better in nonalcoholics compared with alcoholics, but there was no significant difference between cirrhotic nonalcoholics and alcoholics. Variceal rebleeding was rare (4% of Warren procedures) and, when present, was usually related to shunt failure. Gastric fundal variceal rebleeding did not occur in 44 patients undergoing splenopancreatic disconnection. Postoperative encephalopathy occurred in 13% of patients; however, it did not occur at all in noncirrhotic patients. Prograde portal venous perfusion was preserved in 77% of patients. Fifteen alternate selective operations to the Warren shunt were performed, usually because of antecedent splenectomy. Shunt failure and variceal rebleeding occurred more frequently with these more vulnerable shunts, but 66% had a satisfactory outcome. Selective shunts have produced highly satisfactory results in appropriately selected patients.
authors.affiliation: Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: J A
authors.initials: JA
authors.lastname: Myburgh
mesh_terms: D004630:Emergencies; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000401:mortality; D012008:Recurrence; D013164:Splenorenal Shunt, Surgical / Q000401:mortality