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Mesocaval shunt for bleeding oesophageal varices.
E I Nylamo1, M Rautanen, M V Inberg
1Department of Surgery, University of Turku, Finland.
Annales Chirurgiae Et Gynaecologiae
|January 1, 1988
Summary
Mesocaval and interposition shunts effectively reduced portal pressure for bleeding esophageal varices. While emergency surgery had high mortality, late deaths were mainly hepatic coma, not rebleeding.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Vascular Surgery
Background:
- Esophageal varices are a serious complication of portal hypertension, often caused by alcoholic cirrhosis.
- Surgical shunts are employed to reduce portal venous pressure and prevent bleeding.
Purpose of the Study:
- To compare the efficacy and outcomes of end-to-side mesocaval shunts versus interposition shunts for bleeding esophageal varices.
- To evaluate operative mortality, long-term survival, and complications associated with these surgical procedures.
Main Methods:
- A retrospective analysis of 43 patients who underwent either end-to-side mesocaval (25) or interposition (18) shunts between 1970 and 1985.
- Patients were categorized by surgical approach (elective vs. emergency) and Child's classification.
Main Results:
- Operative mortality was 19% for elective and 56% for emergency shunts. Child's C patients had approximately 50% mortality.
- Both shunt types effectively lowered portal venous pressure. Late deaths were primarily due to hepatic coma, with no deaths from recurrent variceal bleeding.
- Two cases of venous leg ulcers occurred after end-to-side shunts. The end-to-side mesocaval shunt was discontinued in favor of interposition shunts.
Conclusions:
- Interposition shunts and end-to-side mesocaval shunts are comparable in reducing portal pressure.
- Emergency shunt surgery for variceal bleeding carries significant mortality risk.
- Hepatic coma is a major cause of late mortality, highlighting the importance of liver function post-surgery.