[The Chang mesocaval side-to-side shunt, an alternative shunt form after previous operations and portal vein thrombosis].
Over the time period from July 01, 1983 to June 01, 1993, 15 patients with portal hypertension and relapsing bleedings from esophageal varicosis were treated with Chang's mesocaval side-to-side shunt at the Department of General Surgery, University Hospital of Göttingen. All patients were pre-operated in the upper abdomen or exhibited thrombosis of the portal vein. While five cases revealed a prehepatic block, ten patients had an intrahepatic block, based on cirrhosis of the liver (Child classification A or B). The time required for operations was 180 +/- 32 minutes; the pressure in the portal circulation decreased by 56%. In three cases, patients suffered relapsing bleedings despite of regular shunt conditions. Complications which were due to the procedure were seen in two patients (one revealed intraabdominal posthemorrhage, followed by therapy-resistant coagulopathy; the other patient exhibited stenosis of the anastomosis). One patient developed encephalopathy. Given a rigid indication, we regard the procedure described herein an alternative to the mesocaval interposition shunt, and we consider the low rate of thrombosis (so far < 10%) without continued postoperative anticoagulant therapy as well as the avoidance of an interposition as important advantages of this technique.
Chirurgische Klinik und Poliklinik, Georg-August-Universität Göttingen.
R
R
Schlemminger
H
H
Köhler
G
G
Lepsien
H J
HJ
Peiper
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000401:mortality / Q000601:surgery*; D008297:Male; D017538:Mesenteric Artery, Superior / Q000601:surgery*; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D015996:Survival Rate; D013536:Suture Techniques; D013927:Thrombosis / Q000401:mortality / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000601:surgery
Der mesokavale Seit-zu-Seit-Shunt nach Chang, eine alternative Shuntform nach Voroperationen und bei Pfortaderthrombose.