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Surgical management of the Budd-Chiari syndrome: early experience
S R Shah1, T S Narayanan, S S Nagral
1Gastroenterology Surgical Services, KEM Hospital, Mumbai.
Insights
Side-to-side portacaval shunt is effective for Budd-Chiari syndrome (BCS) management. Mesoatrial shunts showed disappointing results in this study.
Area of Science:
- Hepatology
- Surgical Gastroenterology
- Vascular Surgery
Background:
- Budd-Chiari syndrome (BCS) requires early decompression to prevent liver dysfunction and mortality.
- Surgical intervention is crucial for managing BCS, particularly in cases of variceal bleeding or chronic obstruction.
Purpose of the Study:
- To investigate surgical technical difficulties encountered during Budd-Chiari syndrome (BCS) treatment.
- To evaluate the outcomes and efficacy of various surgical procedures for BCS.
Main Methods:
- Retrospective review of nine BCS patients operated on between 1994 and 1998.
- Surgical procedures included portacaval shunt, portorenal shunt, mesocaval shunt, mesoatrial shunt, and devascularisation.
- Patient conditions ranged from acute variceal bleeding to chronic BCS, with varying patterns of hepatic vein and inferior vena cava (IVC) obstruction.
Main Results:
- Side-to-side portacaval shunt was technically challenging in three patients due to anatomical variations or IVC stents, necessitating alternative shunts.
- Mesoatrial shunts proved unsuccessful in both attempted cases.
- Devascularisation effectively controlled acute variceal bleeding. Postoperative mortality was 33% (3/9), but 5 of 6 survivors remained asymptomatic at a mean follow-up of 19.7 months.
Conclusions:
- Side-to-side portacaval shunt is an effective surgical option for managing Budd-Chiari syndrome (BCS).
- Mesoatrial shunts yielded poor results and are not recommended for BCS treatment.
- Surgical approach should be tailored to individual patient anatomy and obstruction patterns.
Background:
Early decompression is needed in the Budd-Chiari syndrome (BCS) to prevent liver dysfunction and death.
Aims:
To study the technical difficulties during surgery and the results of surgery for BCS.
Methods:
Retrospective review of nine patients operated on between 1994 and January 1998 for BCS--1 for uncontrolled fundal variceal bleed and 8 for chronic BCS. Isolated hepatic vein block was found in 5, inferior vena cava (IVC) block in 1 and a combination in 3 patients. Preoperative liver biopsies did not reveal cirrhosis in any patient. Portacaval shunt (3), portorenal shunt (2), mesocaval shunt (1), mesoatrial shunt (2) and devascularisation (1) were the operations performed.
Results:
In 3 patients, side-to-side portacaval shunt was not possible because of caudate lobe hypertrophy (1), aberrant right hepatic artery (1) and presence of IVC stent (1); they required portorenal (2) or interposition mesocaval (1) shunts. Both mesoatrial shunts were unsuccessful. Devascularisation was effective in controlling the acute bleed. There was no intraoperative death. Postoperatively there were 3 deaths. Of the 6 survivors, 5 are asymptomatic over a mean follow up of 19.7 months.
Conclusions:
Side-to-side portacaval shunt is effective in the management of BCS; results with the mesoatrial shunt are disappointing.