Should portosystemic shunt be reconsidered in the treatment of intractable ascites in cirrhosis?
Fifty-seven cirrhotic patients with intractable ascites had a portosystemic shunt. In 35 patients, a peritoneovenous shunt had previously failed. Forty-six patients were in Pugh's class B and 11 were in class C. There were three operative deaths (5.3%). Fifty-three (98.2%) of the 54 survivors were cleared of ascites. In one patient, ascites persisted because of postshunt heart failure that resulted in a marked increase of caval pressure. Twenty-seven patients (50%) had late encephalopathy, which was severe and disabling in 12 (22%). One- and three-year survival rates were 72% and 36%, respectively. These results suggest that although portosystemic shunts are remarkably effective in dealing with ascites, the high rate of postoperative encephalopathy is a strong argument against their routine use in the management of intractable ascites in cirrhosis.
Franco
D
D
Department of Research on Surgery of the Liver of Portal Hypertension, University of Paris-Sud, Hôpital Paul Brousse, Villejuif, France.
Vons
C
C
Traynor
O
O
de Smadja
C
C
D000328:Adult; D000368:Aged; D001201:Ascites / Q000601:surgery*; D001794:Blood Pressure; D001927:Brain Diseases / Q000209:etiology; D004932:Esophageal and Gastric Varices / Q000150:complications; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000503:physiopathology; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects / Q000379:methods; D011379:Prognosis