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Mesentericocaval shunt with the internal jugular vein.
Surgery, Gynecology & Obstetrics
|March 1, 1978
Summary
The mesentericocaval shunt shows promise for preventing recurrent bleeding and improving survival rates compared to portocaval shunts. Further randomized studies are needed to confirm its superiority in managing portal hypertension.
Area of Science:
- Hepatology
- Surgical Gastroenterology
- Vascular Surgery
Background:
- Portal hypertension is a serious complication of liver disease, often leading to recurrent bleeding.
- Shunt surgery is employed to decompress the portal venous system and prevent bleeding.
- Mesentericocaval and portocaval shunts are surgical options with varying outcomes.
Purpose of the Study:
- To compare the efficacy of mesentericocaval shunts versus side-to-side portocaval shunts.
- To evaluate protection from recurrent bleeding, shunt patency, encephalopathy, rehabilitation, and survival.
- To assess liver perfusion and the role of octopamine levels.
Main Methods:
- Retrospective analysis of 79 mesentericocaval shunts and 54 portocaval shunts.
- Patient evaluation included follow-up, angiography, and serum octopamine level assessment.
- Actuarial methods were used for long-term survival calculations.
Main Results:
- Mesentericocaval shunts demonstrated 82% patency, 35% encephalopathy, and 65% survival.
- Portocaval shunts had a 54% encephalopathy rate and 38% survival rate.
- 95% of patent mesentericocaval shunts maintained persistent liver perfusion; no octopamine correlation with encephalopathy was found.
Conclusions:
- The mesentericocaval shunt appears more effective than the portocaval shunt regarding encephalopathy incidence and survival rates.
- Persistent liver perfusion is maintained in most patent mesentericocaval shunts.
- A randomized controlled trial is necessary to definitively establish the superiority of the mesentericocaval shunt.