Surgical management of the Budd-Chiari syndrome: early experience.
BACKGROUND
Early decompression is needed in the Budd-Chiari syndrome (BCS) to prevent liver dysfunction and death.


OBJECTIVE
To study the technical difficulties during surgery and the results of surgery for BCS.


METHODS
Retrospective review of nine patients operated on between 1994 and January 1998 for BCS--1 for uncontrolled fundal variceal bleed and 8 for chronic BCS. Isolated hepatic vein block was found in 5, inferior vena cava (IVC) block in 1 and a combination in 3 patients. Preoperative liver biopsies did not reveal cirrhosis in any patient. Portacaval shunt (3), portorenal shunt (2), mesocaval shunt (1), mesoatrial shunt (2) and devascularisation (1) were the operations performed.


RESULTS
In 3 patients, side-to-side portacaval shunt was not possible because of caudate lobe hypertrophy (1), aberrant right hepatic artery (1) and presence of IVC stent (1); they required portorenal (2) or interposition mesocaval (1) shunts. Both mesoatrial shunts were unsuccessful. Devascularisation was effective in controlling the acute bleed. There was no intraoperative death. Postoperatively there were 3 deaths. Of the 6 survivors, 5 are asymptomatic over a mean follow up of 19.7 months.


CONCLUSIONS
Side-to-side portacaval shunt is effective in the management of BCS; results with the mesoatrial shunt are disappointing.
D000328:Adult; D006502:Budd-Chiari Syndrome / Q000601:surgery*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery; D008297:Male; D011170:Portasystemic Shunt, Surgical; D012189:Retrospective Studies; D016896:Treatment Outcome