Prognosis after meso-caval interposition shunt. Experience of eighty-six consecutive cases over a period of ten years.
From January 1st, 1975, up to January 1st, 1986, a meso-caval interposition shunt was performed in 86 patients (electively with one exception), using a 16 or 18 mm lumen Dacron prosthesis. The criteria for selection for operation were a liver volume of 1000-2500 ml, a residual portal perfusion of 15 to 30%, exclusion of an activity of the liver process and stenosis of the hepatic artery or coeliac trunk. The cause of portal hypertension was liver cirrhosis in 77 patients (89.5%), prehepatic block in five (4.5%), liver fibrosis in three patients (3.5%), and myeloproliferative disease in one patient (1%). The study represents a prospective assessment and included 52 men and 32 women with a mean age of 43 years. Intraoperative flow measurement demonstrated a residual portal perfusion in all 17 patients measured after the shunt. In-hospital mortality was 8%, late mortality 39%; the fate of four patients is unknown. The main causes of death were liver failure and hepatocellular carcinoma. The rate of encephalopathies over the whole period was 10.5%. The actual survival rate was over 70% for five and over 50% for ten years. Postoperative angiographic studies confirmed by sequential scintigraphy demonstrated a residual portal perfusion in 75% of the patients postoperatively, 60% after six months and in 38% after two years. Thus it could be demonstrated that the meso-caval interposition shunt is converted to a total shunt in the long term. The total shunt patency rate was 90%. The meso-caval interposition shunt is certainly no ideal procedure but is useful in the selective or semiurgent management of patients with liver cirrhosis and portal hypertension.
Paquet
K J
KJ
Department of Surgery and Medicine, Heinz-Kalk-Hospital, Bad Kissingen, West Germany.
Kalk
J F
JF
Koussouris
P
P
D000328:Adult; D001807:Blood Vessel Prosthesis; D004932:Esophageal and Gastric Varices / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D011093:Polyethylene Terephthalates; D011168:Portal System; D011170:Portasystemic Shunt, Surgical / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
D011093:Polyethylene Terephthalates