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Results and hemodynamic changes after interposition mesocaval shunt.

R K Reznick, B Langer, B R Taylor

    Surgery
    |March 1, 1984
    PubMed
    Summary
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    Interposition mesocaval shunting effectively treats portal hypertension and variceal bleeding, offering a viable alternative to other shunt procedures. Results show similar patency and rebleeding rates, though encephalopathy outcomes varied.

    Area of Science:

    • Hepatology
    • Surgical Gastroenterology
    • Vascular Surgery

    Background:

    • Portal hypertension and variceal bleeding are serious complications of liver cirrhosis.
    • Interposition mesocaval shunting is a surgical option for managing these conditions.
    • Previous studies reported varying outcomes for different shunt procedures.

    Purpose of the Study:

    • To evaluate the efficacy and outcomes of interposition mesocaval shunting in patients with portal hypertension and variceal bleeding.
    • To compare the results of mesocaval shunting with those of end-to-side portocaval shunts.

    Main Methods:

    • A retrospective analysis of 47 patients undergoing interposition mesocaval shunting between 1973 and 1980.
    • Assessment of early mortality, overall survival, rebleeding rates, and postshunt encephalopathy.

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  • Correlation of outcomes with preoperative Child's classification.
  • Postshunt angiography and portal flow studies were performed.

    • Main Results:

    • The study included 47 patients, with alcoholic cirrhosis being the most common underlying disease (56%).
    • Emergency shunting (75% of cases) had a high early mortality rate (43%).
    • Shunt patency was high (90%), but hepatopedal flow was observed in only three patients, often associated with shunt kinking.
    • Outcomes (survival, rebleeding, encephalopathy) correlated with Child's classification, similar to end-to-side portocaval shunts.

    Conclusions:

    • Interposition mesocaval shunting is a reasonable alternative to end-to-side portocaval shunts for portal hypertension.
    • It demonstrates comparable rates of patency, rebleeding, mortality, and encephalopathy.
    • Careful construction is essential to ensure shunt patency and potentially optimize portal flow patterns.