Prophylactic distal splenorenal shunt for child's class A and B patients at high risk of bleeding
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Prophylactic distal splenorenal shunt effectively prevents esophagogastric variceal bleeding in high-risk patients. This surgical procedure demonstrates long-term safety and reliability, with significant survival rates observed over 15 years.
Area of Science:
- Gastroenterology
- Hepatology
- Surgical Gastroenterology
Background:
- Esophagogastric varices pose a significant bleeding risk in patients with liver disease.
- Prophylactic intervention is crucial for selected patients with high-risk varices.
Purpose of the Study:
- To evaluate the efficacy and safety of prophylactic distal splenorenal shunt (DSRS) in preventing variceal bleeding.
- To assess long-term outcomes, including survival and complications, following DSRS.
Main Methods:
- A cohort of 29 patients with high-risk esophagogastric varices underwent prophylactic DSRS over 17 years.
- Procedures included the original Warren shunt (13 patients) and modified DSRS with expanded polytetrafluoroethylene (ePTFE) interposition (16 patients).
- Portal-azygos disconnection was performed in all cases.
Main Results:
- No instances of variceal re-bleeding were reported post-surgery.
- One patient (3.4%) experienced fatal hepatic failure postoperatively.
- Mild to moderate hepatic encephalopathy occurred in 14.3% of patients.
- 5-, 10-, and 15-year survival rates were consistently 85.5%.
Conclusions:
- Distal splenorenal shunt is a safe and effective prophylactic measure against variceal bleeding in carefully selected patients.
- The procedure offers reliable long-term protection and survival benefits for individuals at risk of gastrointestinal hemorrhage from portal hypertension.
Abstract:
During recent 17 years, prophylactic distal splenorenal shunt was carried out on 29 patients. Patients were composed of 18 males and 11 females. Age ranged from 34 to 66 years with an average of 52.4. All patients had risky esophagogastric varices; varices larger than 5 mm in diameter and or varices with red color signs such as cherry red spots endoscopically. Underlying liver disease were cirrhosis of the liver in 27, chronic hepatitis in one, and idiopathic portal hypertension in one. Twenty-three patients were in Child's class A and six were in class B. Thirteen patients underwent the original Warren shunt but the remaining 16 had modified distal splenorenal shunts with expanded polytetrafluoroethylene interposition. Portal-azygos disconnection was routinely performed. One patients (3.4%) died of hepatic failure on the 6th postoperative day. Four patients (14.3%) developed hepatic encephalopathy of mild to moderate degree but no patients have suffered from variceal bleeding until now. The 5-, 10-, and 15-year survival rates were all 85.5 per cent. It is concluded that distal splenorenal shunt is a safe and reliable method to prevent variceal bleeding in a selected group of patients.