title: [Portasystemic shunt--our twenty years experience].
abstract: OBJECTIVE
  It was the aim of this study to demonstrate our experiences over twenty years with portasystemic shunt surgery in patients with chronic liver disease and variceal bleeding.
  
  
  METHODS
  From January 1 st, 1980 to December 31 st, 2000 we performed 90 portasystemic shunt operations (PSO). The patients were divided in two groups. The patients of the first group were operated upon between 1980-1988 (n = 58), patients of the second group (n = 32) between 1988-1998. Both groups did not differ in age, gender and cause of hepatic disease. In the first group the most performed type of shunt was the portacaval shunt, in group II the splenorenal shunt.
  
  
  RESULTS
  We observed an improved early and late mortality rate, encephalopathy rate and reduction of recurrent variceal bleeding in the second group: the early mortality rate decreased from 16 to 9 % (p < 0.01), the late mortality rate from 35 to 6 % (p < 0.05), the encephalopathy rate from 43 to 12 % and the variceal rebleeding rate from 10 to 6 %.
  
  
  CONCLUSIONS
  Selective shunts, such as the distal splenorenal shunt are significantly superior to the standard (end-to-side or side-to-side) portasystemic shunt. In countries where acute treatment of recurrent variceal hemorrhage with sclerotherapy is not available in remote areas or in countries where transplantation procedures are in the very beginning and where TIPPS operations are too expensive, portasystemic shunt operations are the only possibility to save the patients life when sclerotherapy fails.
authors.affiliation: Department of Digestive Surgery, Surgical Clinic, University Hospital Rijeka, Croatia, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Uravić
authors.forename: A
authors.initials: A
authors.lastname: Depolo
authors.forename: R
authors.initials: R
authors.lastname: Dobrila-Dintinjana
authors.forename: I
authors.initials: I
authors.lastname: Kraus
authors.forename: N
authors.initials: N
authors.lastname: Petrosić
authors.forename: D
authors.initials: D
authors.lastname: Stimać
authors.forename: G
authors.initials: G
authors.lastname: Bacić
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D017523:Croatia; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical; D011170:Portasystemic Shunt, Surgical; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D013164:Splenorenal Shunt, Surgical; D015996:Survival Rate