Interposition mesocaval shunt for bleeding esophageal varices: clinical, hemodynamic, and metabolic changes

Twenty-three patients bleeding from varices had mesocaval H-grafts using Dacron prosthetic material. There were 21 men and two women with ages ranging from 37 to 60 years. There were 11 elective and 12 emergency procedures. Five patients (17%) were classified as Child's class A, seven (34%) as class B, and 11 (49%) as class C. An operative mortality of 17% was noted in the entire group, with one late death due to hepatic failure. All deaths occurred in emergency cases belonging to class C. Technical difficulties were encountered more often in the hands of less experienced surgeons. A high rate of shunt patency and minimal problems with postoperative encephalopathy were noted despite abnormal results of ammonia tolerance tests postoperatively. Lack of hepatopedal flow was noted postoperatively compared with preoperative angiograms. There were no serious adverse effects from diversion of blood from the liver in our surviving patients. The interposition mesocaval shunt is a technically safe and easy procedure in the hands of experienced surgeons. We continue to recommend the mesocaval shunt until other methods prove better than this operation.