An analysis of surgical shunts for the management of portal hypertension at Aga Khan University Hospital.
BACKGROUND
The objective of our study was to analyze the outcome of surgical shunts for the management of variceal bleeding associated with portal hypertension.


METHODS
This was a retrospective analysis carried out at The Aga Khan University Hospital, Karachi of medical records from Jan 1991--Dec 2001. The main outcome measures included morbidity and mortality associated with the surgical procedure, and the long term outcome in terms of recurrent bleeding.


RESULTS
A total of 30 patients underwent a shunt procedure during the study period. The mean age was 35+/-13.75 years, with 22 (73%) males and 8 (27%) females. The indication for surgery was recurrent bleeding in 23 (77%) patients, and active bleeding refractory to endoscopic therapy in 7 (23%) patients. According to Child-Pugh classification, 19 (63%) patients were classified as Childs' A, 7 (23%) as Childs' B, and 4 (13%) as Childs' C. The surgical procedure included distal splenorenal shunt in 25 (83%), central splenorenal shunt in 3 (10%), and portocaval shunt in 2 (7%) cases. Five patients expired within 30 days of surgical intervention with mortality rate of 16%. Three of these patients were Childs' C, as compared to one each in Childs' A and B, the difference being statistically significant. Similarly, the frequency of encephalopathy and recurrent bleeding was also significantly higher in patients with Childs' class C.


CONCLUSIONS
Surgical shunts may be considered as a reasonable alternative for long term control of recurrent variceal bleeding in patients with good hepatic reserve.
Luqman
Zubair
Z
Department of Surgery, The Aga Khan University, Karachi.
Khan
Muhammad Rizwan
MR
Alam
Mahboob
M
Atiq
Muslim
M
Sophie
Ziad
Z
D000328:Adult; D005260:Female; D006785:Hospitals, University; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome