[Selective portal-systemic shunts for bleeding portal hypertension].
At the beginning of the seventies, we began to perform regularly selective shunts for the treatment of portal hypertension. In a 15 year period, 177 patients (155 with liver cirrhosis) were operated with three kinds of selective shunts: 128 with a Warren shunt, 29 with an end to end renosplenic shunt and 20 with a splenocaval shunt. 167 cases were operated in an elective fashion. The 15 years global operative mortality, was 14.4%. Operative mortality of the Child A patients, was 11.6%. Survival for the Child A group was 74.6% at 1 year, 68.2% at 5 years and 64.6% at 15 years. Incapacitating encephalopathy was observed in 6.9%, rebleeding 6.2% and shunt thrombosis in 6.2%. Portal vein alterations in the postoperative period were observed: in 13.3% a reduction in diameter ocurred and in 20.5%, thrombosis was recorded. It is concluded that when feasible, the selective shunts are the treatment of choice for portal hypertension in those patients with good liver function.
Orozco
H
H
Clinica de Hipertensión Portal, Instituto Nacional de la Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Tlalpan, 14000, DF México.
Mercado
M A
MA
Takahashi
T
T
García-Tsao
G
G
Guevara
L
L
Hernandez-Ortiz
J
J
Tielve
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D006971:Hypersplenism / Q000453:epidemiology / Q000209:etiology; D006975:Hypertension, Portal / Q000150:complications*; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011169:Portal Vein; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult