Interposition mesocaval shunt for bleeding oesophageal varices in moderate and poor risk cirrhotics

A series of 45 mesocaval interposition shunt operations for bleeding oesophageal varices in Child's class B and C cirrhotics is presented. Twelve operations were carried out electively and 33 as emergencies. The primary mortality rates were 8% and 48% in these groups, respectively. Eleven (39%) of the 28 survivors died during a follow-up of 5 months to 4 years. Cumulative overall survival was 48% at one year and 33% at four years. Mortality was influenced more by surgery if performed as an emergency than the functional reserve of the liver. Continued alcoholism after surgery correlated with late mortality. Two cases of variceal rebleeding occurred in the primary survivor group (7%); both of them had shunt occlusion. Shunt patency rate was 89%. All patients had some degree of encephalopathy before surgery, but severe or chronic cases were not observed during the follow-up. Ascites when present preoperatively always disappeared after shunt. As a technically relatively simple procedure, mesocaval interposition shunt effectively prevents variceal rebleeding and ascites formation, thus offering improvement also in the quality of life. In elective cases an acceptably low mortality is achieved even in poor risk patients. In emergency cases mesocaval shunt provides about 50% chance of survival, if conservative methods to stop the bleeding fail.