title: Distal splenorenal shunt for non-cirrhotic variceal bleeding in black South Africans.
abstract: Distal splenorenal shunt (DSRS) is a once-only form of treatment. It is suitable for many black South Africans with non-cirrhotic variceal bleeding who cannot attend repeated follow-up sclerotherapy sessions. However, persistent hyperbilirubinaemia and encephalopathy may occur following DSRS in schistosomiasis. Forty-one consecutive patients with DSRS have been treated over a 7-year period. The causes of portal hypertension were schistosomiasis (32), portal vein thrombosis (8) and diffuse nodular hyperplasia (1). Operative mortality was 6%. Encephalopathy was observed in 1 patient. Galactose elimination capacity (GEC) and technetium-diethylenetriamine penta-acetic acid hepatic perfusion index (HPI) were used to assess liver function and hepatic perfusion pre- and postoperatively, respectively, in schistosomiasis. GEC was 348 +/- 37 (M +/- SD) before, compared with 343 +/- 67 postoperatively (P = 0.78). HPI showed long-term preservation of hepatopetal portal venous flow following DSRS. Morbidity and mortality were observed only in patients with schistosomiasis associated with hepatitis B chronic active hepatitis. DSRS is ideal treatment in selected patients with non-cirrhotic variceal bleeding.
authors.affiliation: Department of Surgery, Medical University of Southern Africa, Pretoria.
authors.forename: M C
authors.initials: MC
authors.lastname: Modiba
authors.forename: Z
authors.initials: Z
authors.lastname: Koto
authors.forename: T A
authors.initials: TA
authors.lastname: Lowan
authors.forename: S
authors.initials: S
authors.lastname: Magano
authors.forename: I
authors.initials: I
authors.lastname: Segal
authors.forename: J
authors.initials: J
authors.lastname: Esser
authors.forename: D
authors.initials: D
authors.lastname: Pantanowitz
authors.forename: J A
authors.initials: JA
authors.lastname: Myburgh
mesh_terms: D000328:Adult; D001741:Black or African American; D044383:Black People; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D008102:Liver Circulation; D011169:Portal Vein; D011446:Prospective Studies; D012552:Schistosomiasis / Q000150:complications; D013019:South Africa; D013164:Splenorenal Shunt, Surgical; D013927:Thrombosis / Q000150:complications