Shunting and nonshunting procedures for the treatment of esophageal varices in patients with idiopathic portal hypertension.

Abstract

BACKGROUND/AIMS:

We evaluated the results of shunting and nonshunting procedures for the treatment of esophagogastric varices in patients with idiopathic portal hypertension (IPH).

METHODOLOGY:

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: Hiroshi Yoshida, Yasuhiro Mamada, Nobuhiko Taniai, Sho Mineta, Yoichi Kawano, Yoshiaki Mizuguchi, Tomohiro Kanda, Takashi Tajiri
• Journal: Hepato-gastroenterology (Hepatogastroenterology) 2010 Sep-Oct Vol. 57 Issue 102-103 Pg. 1139-44 ISSN: 0172-6390 [Print] Greece
• PMID: 21410046 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Esophageal and Gastric Varices (blood, surgery)
• Female
• Humans
• Hypertension, Portal (complications)
• Male
• Middle Aged
• Platelet Count
• Splenorenal Shunt, Surgical
• Young Adult