Mesocaval interposition shunting in the treatment of bleeding oesophageal varices.
OBJECTIVE
To assess the longterm results of mesocaval interposition shunt in the treatment of bleeding oesophageal varices.


METHODS
Retrospective study.


METHODS
University hospital, Sweden.


METHODS
60 patients with bleeding oesophageal varices in all Child's classes. 20 of whom were operated on as emergencies, and 40 as elective cases.


METHODS
A 14 mm polytetrafluoroethylene graft was used as an interposition shunt between the superior mesenteric vein and the vena cava.


METHODS
Rebleeding rate, portal blood flow, hepatic encephalopathy, morbidity, mortality, and survival.


RESULTS
Rebleeding was rare and occurred mainly during the first 4 months after operation, (n = 5) in 10% of the patients, and at the 24 month follow-up, (n = 4) in 11% of the patients. Portal flow was measured preoperatively in 33 patients and in 22 (67%) it was hepatopetal. During follow-up it was reversed and after 24 months no patient had hepatopetal flow. Hepatic encephalopathy was present in 18 patients (20%) during follow-up. Shunts thrombosed in 9 patients (15%), 8 of which required reoperation. There was no operative mortality, but 4 patients (7%) died within 30 days of surgery. The main late cause of death (18/26) was liver failure. The 1 year survival was 80%, the 3 year survival 70% and the 5 year survival 60%.


CONCLUSIONS
The mesocaval interposition shunt gives good longterm results and can be recommended both as an emergency and an elective procedure for patients with portal hypertension and bleeding oesophageal varices that are unresponsive to sclerotherapy.
Isaksson
B
B
Department of Surgery, Lund University Hospital, Sweden.
Hannesson
P
P
Rosén
I
I
Jeppsson
B
B
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001807:Blood Vessel Prosthesis / Q000009:adverse effects / Q000379:methods*; D002423:Cause of Death; D016009:Chi-Square Distribution; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011167:Portacaval Shunt, Surgical / Q000379:methods; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013548:Sweden
D011138:Polytetrafluoroethylene