title: Shunting and nonshunting procedures for the treatment of esophageal varices in patients with idiopathic portal hypertension.
abstract: OBJECTIVE
  We evaluated the results of shunting and nonshunting procedures for the treatment of esophagogastric varices in patients with idiopathic portal hypertension (IPH).
  
  
  METHODS
  Between 1981 and 2008, surgery was performed in 9 patients with IPH. Three patients were bleeding before operation, and the other 6 were treated prophylactically. Patients were divided into 2 groups, a shunting group (4 underwent distal splenorenal shunt) and a nonshunting group (3 underwent esophageal transection and 2 underwent Hassab's procedure).
  
  
  RESULTS
  Esophagogastric varices were completely eradicated in 3 (75.0%) patients in the shunting group and 4 patients (80.0%) in the nonshunting group. Additional endoscopic treatment (one session) was performed in 2 patients with incompletely eradicated varices. There was no recurrence in the shunting group. In the nonshunting group, esophagogastric varices recurred in all 4 patients with completely eradicated varices. All recurrent esophageal varices were completely eradicated. Postoperative platelet counts (x10(4)/microL) were significantly lower in the shunting group (10.0 +/- 2.6) than in the nonshunting group (42.0 +/- 14.0) (p = 0.0029). The increase in the platelet count after operation was significantly lower in the shunting group (1.7 +/- 0.2 times) than in the nonshunting group (5.8 +/- 2.9 times) (p = 0.0267). No patient received anticoagulants postoperatively. Portal venous thrombus did not develop in the shunting group, but appeared in 4 patients (80.0%) in the nonshunting group. No patient had loss of shunt selectivity or portal-systemic encephalopathy. One patient in the nonshunting group died of cerebral hemorrhage; all others are alive.
  
  
  CONCLUSIONS
  Shunting procedure, distal splenorenal shunt, was suggested to be useful for the management of esophagogastric varices in patients with IPH.
authors.affiliation: Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. hiroshiy@nms.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Mamada
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Taniai
authors.forename: Sho
authors.initials: S
authors.lastname: Mineta
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Kawano
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Mizuguchi
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kanda
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
mesh_terms: D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000601:surgery*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D013164:Splenorenal Shunt, Surgical; D055815:Young Adult