Comparative study of selective shunts v.s. nonshunt procedures in the treatment of esophageal varices

Results of selective shunts and nonshunt procedures in elective treatment of esophagogastric varices were retrospectively evaluated. There were 40 patients undergoing selective shunts; 31 distal splenorenal shunts and 9 left gastric vena caval shunts. Thirty-three patients underwent nonshunt procedures; 9 esophageal transections, 11 transections or resections of the cardia, and 13 Hassab procedures. Operative mortality rate (0.05 less than P less than 0.1) and incidence of recurrent variceal bleeding (0.1 less than P less than 0.2) tended to be higher in the nonshunt group than in the selective shunt group. Postoperative hepatic encephalopathy was seen in three patients of the selective and in one instance of the nonshunt groups. The late survival and rehabilitation status of the patients were similar in both groups. The present results, although not prospectively randomized, seem to indicate that selective shunts are preferred to nonshunt procedures in the elective treatment of esophagogastric varices.