Portacaval shunt in the treatment of primary Budd-Chiari syndrome
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Side-to-side portacaval shunt effectively manages primary Budd-Chiari syndrome. This surgical procedure relieved ascites and prevented encephalopathy in most patients, offering a reliable treatment option.
Area of Science:
- Hepatology
- Surgical Gastroenterology
- Vascular Surgery
Background:
- Primary Budd-Chiari syndrome presents with hepatomegaly and massive ascites.
- Esophageal varices are common, though bleeding episodes may be absent preoperatively.
- Diagnosis requires comprehensive evaluation including imaging, biopsy, and liver function tests.
Purpose of the Study:
- To evaluate the efficacy of side-to-side portacaval shunt in managing primary Budd-Chiari syndrome.
- To assess the safety and long-term outcomes of this surgical intervention.
Main Methods:
- A cohort of six patients with primary Budd-Chiari syndrome underwent side-to-side portacaval shunt.
- Preoperative assessments included angiography, pressure measurements, laparoscopy, biopsy, and liver function tests.
- Shunt procedures involved either a direct shunt or one with a graft interposition.
Main Results:
- Four of five surviving patients achieved complete ascites resolution and showed good recovery.
- No surviving patients developed hepatic encephalopathy post-surgery.
- Shunt patency was confirmed by endoscopic variceal decompression in patients with esophageal varices.
Conclusions:
- Side-to-side portacaval shunt is a reliable and effective procedure for definitive management of primary Budd-Chiari syndrome.
- The procedure demonstrates significant success in alleviating key symptoms and preventing complications like encephalopathy.
Abstract:
We have performed a side-to-side portacaval shunt as the treatment of choice in six cases of primary Budd-Chiari syndrome. All the patients (three men and three women, mean age 33 years) had marked hepatomegaly and massive ascites. Four patients had endoscopically proved esophageal varices with no episodes of bleeding. Preoperative angiographic studies, caval pressure measurement, laparoscopy, liver biopsy specimens, liver scanning, and liver function tests confirmed the diagnosis. A possible etiologic factor was evident in only two cases. A plain side-to-side portacaval shunt was performed in four patients, while two required the interposition of a graft. One patient died after surgery of hepatorenal syndrome. Four of the surviving patients are free of ascites and doing well at 29, 27, 25, and 6 months. The remaining patient subsequently developed cirrhosis and died 76 months after surgery. None of the patients who survived developed encephalopathy. Shunt patency was confirmed endoscopically by variceal decompression in the four patients with esophageal varices. We believe the side-to-side portacaval shunt is a reliable and effective procedure for the definitive management of primary budd-Chiari syndrome.