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Survival and quality of life after selective portasystemic shunts
Insights
Selective portasystemic shunts effectively reduce mortality from variceal bleeding, especially in Child
Area of Science:
- Hepatology
- Surgical Gastroenterology
Background:
- Portal hypertension is a serious complication of liver disease, often leading to variceal bleeding.
- Surgical shunts are used to decompress the portal venous system.
Purpose of the Study:
- To evaluate the safety and efficacy of selective portasystemic shunts in patients with portal hypertension.
- To compare outcomes across different shunt types and Child's classes.
Main Methods:
- Retrospective analysis of 55 consecutive patients undergoing selective portasystemic shunts.
- Procedures included end-to-end selective renosplenic, distal splenorenal, and splenocaval shunts.
- Patients were classified using Child's criteria (A, B, C).
Main Results:
- Overall hospital mortality was 16%, lower in Child's class A.
- Five-year survival was 59% overall, significantly higher for class A (83%) versus B/C (36%).
- Long-term complications (encephalopathy, bleeding) occurred in 2/36 survivors.
Conclusions:
- Selective portal shunts are a safe and effective method for reducing mortality in Child's class A patients with variceal bleeding.
- These shunts offer a viable treatment option for managing complications of portal hypertension.
- Outcomes are strongly influenced by the patient's pre-operative liver function (Child's class).
Abstract:
Selective portasystemic shunts were performed in 55 consecutive patients; 27 underwent end-to-end selective renosplenic shunt, 18 distal splenorenal shunt and 10 splenocaval shunt. Thirty-one patients were in Child's class A, 18 were in class B and 6 in class C. Hospital mortality for the whole group was 16 percent and occurred less frequently in class A than in class B and C patients. Five year predicted survival for the whole group was 59 percent. At the same period of follow-up, class A patients had a higher survival rate than those in class B and C (83 percent versus 36 percent; p < 0.01). No striking difference in 5 year survival was evident in alcoholics and nonalcoholics (52 percent versus 61 percent). After surgery, long-term portasystemic encephalopathy and bleeding were noted in 2 of 36 survivors. For class A patients, selective portal shunts offer an adequate and relative safe method for decreasing mortality due to variceal bleeding.