In a prospective study, conducted between 1.1.1987 and 31.12.1992, 72 consecutive patients (50 men, 22 women; mean age 59.8 [16-72] years) with
cirrhosis of the liver and recurrent
bleeding from oesophageal or fundal
varices, were treated with a mesocaval interposition shunt, made of reinforced
Goretex 10 or 12 mm in diameter. Further selection criteria were Child-Pugh class A (n = 39) or B (n = 33), liver volume (by ultrasound) between 1000 and 2500 ml, portal vein perfusion index of at least 10% and histological exclusion of activity or progression of the
cirrhosis. Four patients (5.6%) died during the first 30 days after the intervention, and four had recurrent
bleeding from the
varices, three of them during the postoperative period, one during the second postoperative year. The cumulative shunt patency rate was 94.4% (up to 84 months). An acute
encephalopathy occurred in six patients (8.3%), which was successfully treated with
protein restriction and
neomycin administration. Intra- and post-operative hemodynamic investigation confirmed maintenance of portal-vein perfusion in all patients, but there was a significant tendency towards reduction after 3 years in all patients. The overall survival rate after 7 years was 75%, with 85% for patients in Child-Pugh class A and 65% for those in class B. The results indicate that the described method can achieve satisfactory portal
decompression with maintenance of portal-vein flow. It is especially suitable as a standard method if
sclerotherapy has failed.