Improved quality of life after distal splenorenal shunt. A prospective comparison with side-to-side portacaval shunt.
The distal splenorenal shunt (DSRS) was compared with the side-to-side portacaval shunt (PCS) in 93 prospectively matched patients with portal hypertension. After 38 months mean follow-up the two shunts had a different incidence of acute encephalopathy (22% in PCS group and 33% in DSRS group) and chronic encephalopathy (35% in PCS group and 17% in DSRS group), but the difference was not statistically significant. However, the only cases of severe and disabling chronic encephalopathy arose after PCS (p = 0.049). Actuarial curves of chronic encephalopathy showed that the maximum rate of encephalopathy (18%) in the DSRS group was reached 27 months after shunt surgery, whereas this value was reached and passed in PCS group only 4 months after shunt. Chronic encephalopathy occurred for a total duration of 20.1 months after PCS and only 11.1 months afer DSRS (p = 0.003) and occupied 46.3% of the follow-p of PCS patients, as contrasted to 18.7% of the follow-up of DSRS patients (p = 0.0001). DSRS is associated with a lower global incidence of chronic HE without severe forms and provides a better quality of life than does a nonselective shunt.
Spina
G
G
San Paolo Institute of Biomedical Science, Department of Surgical Semeiology, Milan, Italy.
Santambrogio
R
R
Opocher
E
E
Galeotti
F
F
Cucchiaro
G
G
Strinna
M
M
Pezzuoli
G
G
D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D011788:Quality of Life; D013164:Splenorenal Shunt, Surgical / Q000009:adverse effects / Q000379:methods*