Controversy remains about the best treatment for patients with esophagogastric variceal
bleeding. In spite of different therapeutic alternatives and recent progress, such as
liver transplantation of
TIPS, many patients will finally be treated by standard surgery. With the aim to know the results of surgery in shunting vs non-shunting procedures, we have analyzed a recent and consecutive series of 68 cirrhotics patients operated on for variceal
hemorrhage. According to the surgical technique there were three groups: I) 30 patients underwent a total
portacaval shunt; II) 18 cases with an azygosportal disconnection; III) 20 patients with a partial
portacaval shunt (8-10 mm H-portacaval
PTFE graft). All groups were homogeneous considering age, sex etiology, Child-Pugh grade and timing of surgery (elective vs urgent). The complications and mortality rates were similar for the three groups. The overall operative mortality was 10%, and 5% in selected cases (Child-Pugh A-B, non urgent cases). With a follow-up for I, II and III group of 47, 44 and 27 months respectively,
chronic encephalopathy have been seen in 61%, 15% and 15% respectively (p < .05). No patient in group I has rebled, and only one case in the II and III groups had a recurrence of
hemorrhage. The actuarial three years survival was 76%, 86% and 85% (p NS), and the five year survival was 41% vs 86% for the groups I and II respectively (p < .05). In conclusion, in selected cases, surgery gives excellent immediate and long term results. In patients with variceal
bleeding and failure of first line treatments, such as
sclerosis or pharmacology, the partial H-
portacaval shunt and non-shunting procedures are good alternatives, with low incidence of rebleeding and
chronic encephalopathy.