Late results of mesocaval interposition shunting for bleeding oesophageal varices.
Survival, encephalopathy and shunt patency were studied in 64 consecutive patients who underwent mesocaval shunting with a wide-calibre Dacron prosthesis. Half of the patients were operated as emergency cases. Operative blood loss in patients who had emergency procedures was significantly higher than during elective operations. Overall, 30-day mortality was 27 per cent. Survival was 61 per cent after 1 year and 39 per cent after 5 years. Serious encephalopathy requiring hospital admission occurred in 5 patients (11 per cent of patients surviving more than 1 month). Shunt patency was assessed by scintisplenoportography and ultrasonography. Cumulative shunt occlusion rate was 16 per cent after 1 year, 33 per cent after 5 years and 52 per cent after 8 years of follow-up. Out of 17 patients with an occluded shunt, 9 had persistent or recurrent bleeding, while 3 patients had recurrent bleeding despite a patent shunt. We conclude that the mesocaval Dacron interposition shunt should not be recommended as the procedure of first choice for portosystemic shunting.
D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D013997:Time Factors