Distal splenorenal versus lienorenal shunt for acute variceal haemorrhage: is the selective shunt an advance?
Retrospective analysis of 81 patients (average age 48 years) undergoing lienorenal shunt (28) or distal splenorenal (Warren) shunt (53) surgery over a 15-year period (1971-1986) revealed important predictive factors for survival, but showed no significant differences between the two shunt groups in terms of accepted follow-up data over a period of up to 15 years. In 52 patients (64%) active haemorrhage was occurring at the time of operation, or was temporarily controlled by tamponade, and 17 of the 18 deaths (22% operative mortality) occurred in this group. Patients in whom prolonged conservative resuscitation had been attempted fared worse (64% survival), as did patients with poor hepatic reserve (Pugh grade C: 32% survival). Twenty-two patients (27%) rebled within 30 days, 18 following urgent shunts, and 12 died. Seven (11%) of the long-term survivors have suffered recurrent variceal haemorrhage with a clear relationship to shunt or portal system thrombosis. Portasystemic encephalopathy occurred in 13 survivors (20%) with six requiring hospital treatment.
Lodge
J P
JP
Mavor
A I
AI
Giles
G R
GR
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002648:Child; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013164:Splenorenal Shunt, Surgical / Q000379:methods*