Surgical portosystemic shunts for treatment of portal hypertensive bleeding: outcome and effect on liver function.
BACKGROUND
Since the advent of liver transplantation and transjugular intrahepatic portosystemic shunts (TIPS), the role of surgical portosystemic shunts in the treatment of portal hypertension has changed. However, we have continued to use portosystemic shunts in patients with noncirrhotic portal hypertension and in patients with Child's A cirrhosis.


METHODS
We performed 48 surgical portosystemic shunt procedures between 1988 and 1998. The outcomes of these patients were evaluated to assess the efficacy of this treatment. Data from 39 of 48 patients were available for analysis. The average follow-up was 42 months.


RESULTS
Liver function generally remained stable for the patients; only 2 patients had progressive liver failure and required transplant procedures. Gastrointestinal bleeding (3 patients), encephalopathy (3 patients), and shunt thrombosis (3 patients) were rare. Patient survival was 81% at 4 years, similar to survival with liver transplantation (P = .22).


CONCLUSIONS
Surgical shunts remain the treatment of choice for prevention of recurrent variceal bleeding in patients with good liver function and portal hypertension.
Knechtle
S J
SJ
Department of Surgery, University of Wisconsin Medical School, Madison, USA.
D'Alessandro
A M
AM
Armbrust
M J
MJ
Musat
A
A
Kalayoglu
M
M
D000641:Ammonia / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002423:Cause of Death; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006083:Graft Occlusion, Vascular; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008099:Liver / Q000098:blood supply / Q000503:physiopathology* / Q000601:surgery; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000601:surgery; D008105:Liver Cirrhosis, Biliary / Q000150:complications / Q000601:surgery; D011167:Portacaval Shunt, Surgical; D012709:Serum Albumin; D016019:Survival Analysis; D016896:Treatment Outcome
D012709:Serum Albumin; D000641:Ammonia; D001663:Bilirubin