Selective variceal decompression and its role relative to other therapies

• Published in: The American journal of surgery Vol. 160; no. 1; p. 60
• Main Authors: Maffei-Faccioli, A, Gerunda, G E, Neri, D, Merenda, R, Zangrandi, F, Meduri, F
• Format: Journal Article
• Language: English
• Published: United States 01-07-1990
• Subjects: Esophageal and Gastric Varices - complications; Esophageal and Gastric Varices - mortality; Esophageal and Gastric Varices - surgery; Female; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - surgery; Hepatic Encephalopathy - etiology; Humans; Male; Middle Aged; Postoperative Complications; Splenorenal Shunt, Surgical - adverse effects; Splenorenal Shunt, Surgical - methods
• ISSN: 0002-9610
• DOI: 10.1016/S0002-9610(05)80870-0

Seventy patients, selected from 265 patients with proved variceal bleeding, underwent a distal splenorenal shunt (DSRS) procedure with or without splenopancreatic disconnection (SPD). Alcoholic cirrhosis was the cause of portal hypertension in 57% of the patients. The operative mortality was 13% (Child's classes A and B 2%, class C 66%). Despite fewer varices in all of the patients, variceal rebleeding and death occurred in one patient (2%). Late portal perfusion was observed in 91% of the patients, with worsening in 23%, compared with the preoperative study. Persistent hepatocyte necrosis and incomplete SPD were the most significant prognostic factors for decreased perfusion (presence and absence of necrosis, 38% and 12%, respectively; DSRS and DSRS with SPD, 43% and 12%, respectively). SPD also decreased ongoing hepatocyte damage. Post-shunt encephalopathy was clinically evident in 7% of the patients, but after electroencephalographic evaluation, it increased to 24.6%. Significant factors in its development included decreased portal perfusion (62% versus 14%), active hepatitis (48% versus 17%), and incomplete SPD (43% versus 14%). The higher late liver-related mortality was associated with a lack of or decreased portal perfusion and the absence of SPD.