Long-term results of modified distal splenorenal shunts for the treatment of esophageal varices.
OBJECTIVE
Long-term results were compared for 3 types of distal splenorenal shunt for the treatment of esophageal varices.


METHODS
Between July 1983 and December 1997, 45 patients with esophageal varices underwent distal splenorenal shunt. Group 1 underwent standard distal splenorenal shunt (n = 11). Group 2 underwent distal splenorenal shunt with splenopancreatic disconnection (n = 11). Group 3 underwent distal splenorenal shunt with splenopancreatic disconnection and gastric transection (n = 23).


RESULTS
Additional treatment for recurrent varices was required in group 1, (n = 1, 9.1%), group 2 (n = 2, 18.2%), and group 3 (n = 1, 4.3%). All of the patients with recurrent varices developed a shunt stenosis within the 1st year after distal splenorenal shunt. The prevalence of hyperammonemia in group 1 was 40.0% at 1, 5, and 10 years. In group 2, the prevalence was 14.3% at 1 year, 31.4% at 5 years, and 54.3% at 10 years. In group 3, the prevalence was 0% at 1 year, and 9.1% at 5 and 10 years. The differences between group 3 and groups 1 and 2 were significant (P < 0.01). The cumulative survival rates at 1 year were 90.9%, 63.6%, and 95.7% for groups 1, 2, and 3, respectively. At 10 years, the cumulative survivals rates were 70.7%, 63.6%, and 69.4% for groups 1, 2, and 3, respectively. There were no significant differences in survival between the 3 groups.


CONCLUSIONS
Distal splenorenal shunt with splenopancreatic disconnection and gastric transection may reduce the incidence of postoperative hyperammonemia.
Tajiri
T
T
First Department of Surgery, Nippon Medical School, Tokyo, Japan.
Onda
M
M
Yoshida
H
H
Mamada
Y
Y
Taniai
N
N
Umehara
M
M
Toba
M
M
Yamashita
K
K
D000328:Adult; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005260:Female; D006801:Humans; D022124:Hyperammonemia / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000517:prevention & control; D011859:Radiography; D013164:Splenorenal Shunt, Surgical / Q000379:methods; D016896:Treatment Outcome