This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Role in the Present Management of Variceal Bleeding

Layton F. Rikkers, MD; Gongliang Jin, MD

Arch Surg. 1995;130(5):472-477.

Abstract
Objective
To evaluate the results of selective and non-selective emergency portosystemic shunts in patients with acute variceal hemorrhage.

Design
Retrospective review.

Setting
University medical center and Veterans Affairs medical center.

Patients
Forty-two consecutive patients who underwent emergency portosystemic shunts from 1978 through 1994. All patients had chronic liver disease (29 [69%] had alcoholic cirrhosis) and half had Child's class C disease. Sixteen patients were actively bleeding at the time of surgery, and 26 had bled within 48 hours. Twenty-two patients underwent a nonselective shunt and 20 underwent a distal splenorenal shunt. The percentages of patients with Child's class C disease and with active bleeding at the time of surgery were significantly higher in the nonselective shunt group.

Main Outcome Measures
Operative mortality; early postoperative rebleeding, shunt patency, encephalopathy, and ascites; and long-term survival.

Results
Operative mortality rates were higher in patients with Child's class C disease (43% [9/21]) than in patients with Child's class A or B disease (9% [2/21]) and were higher in patients with active bleeding (all of whom underwent nonselective shunt) (44% [7/16]) than in patients who underwent distal splenorenal shunt (10% [2/20]). All shunts were patent after surgery, and no patient had rebleeding during the early postoperative interval. Early postoperative ascites and encephalopathy rates were similar after nonselective shunt and distal splenorenal shunt. Long-term survival was superior in the lower-risk distal splenorenal shunt group.

Conclusions
Even though more effective nonoperative treatments are now available, emergency portosystemic shunt remains an important option for selected patients with acute variceal hemorrhage. When bleeding can be temporarily controlled by nonoperative means, distal splenorenal shunt is an effective and safe emergency procedure. The mortality rate remains high for patients with Child's class C disease undergoing portal decompression.

(Arch Surg. 1995;130:472-477)

Author Affiliations
From the Department of Surgery, University of Nebraska Medical Center, Omaha.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Distal Splenorenal Shunt: Role, Indications, and Utility in the Era of Liver Transplantation
Jenkins et al.
Arch Surg 1999;134:416-420.
ABSTRACT | FULL TEXT