Experience with 49 consecutive dacron interposition mesocaval shunts. A unified approach to portasystemic...

In 1973, a plan was developed to manage all patients with bleeding esophageal varices who required portasystemic decompression with a Dacron interposition mesocaval shunt procedure. This paper has analyzed 7 years of such experience in 49 consecutive patients. Forty-eight were cirrhotic, 26 (53 percent) required emergency shunting, and 6 were in Child's class A, 13 were in class B and 30 were in class C. Overall, operative mortality was 11 of 49 patients (22.4 percent). Ten of the 11 deaths were of patients in class C and all but one of the patients (90.9 percent) had undergone an emergency operation. Sixteen patients had episodes of significant postshunt recurrent bleeding. Such bleeding occurring within 30 days of operation was a function of severe hepatic, hematologic, and general metabolic derangements. Recurrent hemorrhage occurring after discharge was a function of shunt thrombosis (four patients) or alcoholic recidivism. Twelve patients (31.6 percent) had significant postshunt encephalopathy. Cumulative 5 year survival was 49.3 percent. These data emphasize the high risk of mortality in class C patients operated on an emergency basis. Postoperative encephalopathy is a significant problem with this shunting procedure.