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[The Chang mesocaval side-to-side shunt, an alternative shunt form after previous operations and portal vein
R Schlemminger1, H Köhler, G Lepsien
1Chirurgische Klinik und Poliklinik, Georg-August-Universität Göttingen.
Insights
Chang
Area of Science:
- Hepatology and Surgical Gastroenterology
- Vascular Surgery
Context:
- Portal hypertension management
- Esophageal varices bleeding
- Surgical treatment options
Purpose:
- Evaluate Chang's mesocaval side-to-side shunt for portal hypertension
- Assess efficacy and complications of the shunt procedure
Summary:
- 15 patients with portal hypertension and variceal bleeding underwent Chang's mesocaval side-to-side shunt.
- The procedure reduced portal pressure by 56% with a low thrombosis rate (<10%) and avoided interposition grafts.
- Complications included posthemorrhage, coagulopathy, anastomosis stenosis, and encephalopathy in a few patients.
Impact:
- Chang's shunt offers an alternative to mesocaval interposition shunts.
- Low thrombosis rates and avoidance of interposition are key advantages.
- Highlights the importance of rigid indication for successful outcomes.
Abstract:
Over the time period from July 01, 1983 to June 01, 1993, 15 patients with portal hypertension and relapsing bleedings from esophageal varicosis were treated with Chang's mesocaval side-to-side shunt at the Department of General Surgery, University Hospital of Göttingen. All patients were pre-operated in the upper abdomen or exhibited thrombosis of the portal vein. While five cases revealed a prehepatic block, ten patients had an intrahepatic block, based on cirrhosis of the liver (Child classification A or B). The time required for operations was 180 +/- 32 minutes; the pressure in the portal circulation decreased by 56%. In three cases, patients suffered relapsing bleedings despite of regular shunt conditions. Complications which were due to the procedure were seen in two patients (one revealed intraabdominal posthemorrhage, followed by therapy-resistant coagulopathy; the other patient exhibited stenosis of the anastomosis). One patient developed encephalopathy. Given a rigid indication, we regard the procedure described herein an alternative to the mesocaval interposition shunt, and we consider the low rate of thrombosis (so far < 10%) without continued postoperative anticoagulant therapy as well as the avoidance of an interposition as important advantages of this technique.