Enhanced survival in patients with variceal bleeding after elective portal decompression

In a retrospective study of 49 patients who had bled from esophageal varices but who survived and did not require emergency portal decompression, 24 patients were discharged without surgical consultation and 25 underwent portal decompression using a small-stoma portacaval shunt. Shunted and nonshunted patients were similar both demographically and in clinical and chemical criteria for preoperative hepatocellular function. Among nonshunted patients, survival was 33 percent during a follow-up period of up to 39 months, whereas shunted patients had an 83 percent survival during a follow-up period of up to 43 months. This difference in survival was statistically significant (p = 0.03). Shunted patients showed a 10.5 percent incidence of hepatic encephalopathy. We conclude that survival after variceal hemorrhage may be significantly increased by a portacaval shunt procedure, especially if it is carried out semielectively in stable patients.