Long-term results of modified distal splenorenal shunts for the treatment of esophageal varices.

Abstract

BACKGROUND/AIMS:

Long-term results were compared for 3 types of distal splenorenal shunt for the treatment of esophageal varices.

METHODOLOGY:

Between July 1983 and December 1997, 45 patients with esophageal varices underwent distal splenorenal shunt. Group 1 underwent standard distal splenorenal shunt (n = 11). Group 2 underwent distal splenorenal shunt with splenopancreatic disconnection (n = 11). Group 3 underwent distal splenorenal shunt with splenopancreatic disconnection and gastric transection (n = 23).

RESULTS:

Additional treatment for recurrent varices was required in group 1, (n = 1, 9.1%), group 2 (n = 2, 18.2%), and group 3 (n = 1, 4.3%). All of the patients with recurrent varices developed a shunt stenosis within the 1st year after distal splenorenal shunt. The prevalence of hyperammonemia in group 1 was 40.0% at 1, 5, and 10 years. In group 2, the prevalence was 14.3% at 1 year, 31.4% at 5 years, and 54.3% at 10 years. In group 3, the prevalence was 0% at 1 year, and 9.1% at 5 and 10 years. The differences between group 3 and groups 1 and 2 were significant (P < 0.01). The cumulative survival rates at 1 year were 90.9%, 63.6%, and 95.7% for groups 1, 2, and 3, respectively. At 10 years, the cumulative survivals rates were 70.7%, 63.6%, and 69.4% for groups 1, 2, and 3, respectively. There were no significant differences in survival between the 3 groups.

CONCLUSIONS:

Distal splenorenal shunt with splenopancreatic disconnection and gastric transection may reduce the incidence of postoperative hyperammonemia.

• Authors: T Tajiri, M Onda, H Yoshida, Y Mamada, N Taniai, M Umehara, M Toba, K Yamashita
• Journal: Hepato-gastroenterology (Hepatogastroenterology) 2000 May-Jun Vol. 47 Issue 33 Pg. 720-3 ISSN: 0172-6390 [Print] Greece
• PMID: 10919018 (Publication Type: Journal Article)

Topics

• Adult
• Esophageal and Gastric Varices (surgery)
• Female
• Humans
• Hyperammonemia (prevention & control)
• Male
• Middle Aged
• Portal System (diagnostic imaging)
• Postoperative Complications (prevention & control)
• Radiography
• Splenorenal Shunt, Surgical (methods)
• Treatment Outcome