Medium aperture meso-caval shunts reliably prevent recurrent variceal hemorrhages
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Updated: Aug 18, 2026
Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
C H Scudamore1, S R Erb, C Morris
1Section of Hepatobiliary and Pancreatic Surgery, University of British Columbia, Vancouver, Canada.
Background:
Objectives of partial medium aperture mesocaval shunts (MCS) include reduction of portal hypertension to prevent recurrent variceal hemorrhage, preservation of portal flow through liver while maintaining an intact porta hepatis to facilitate a future liver transplant (OLTx).
Patients And Methods:
Fifteen patients were retrospectively analyzed to review the indications for the procedure, its short- and long-term complications as well as patency and functional status of the shunt. They were followed for a period of 21 months.
Results:
The perioperative and long-term mortality rate was 0%. Rebleeding rate perioperatively and in follow-up was 0%. Early shunt nonfunction was 13% and post-shunt encephalopathy (PSE) was 20%. The encephalopathy was grade I to II and controlled medically. Abdominal ultrasound and Doppler confirmed 13 patent shunts (2 patients did not agree to ultrasound) with preserved hepatopetal flow in 10.
Conclusions:
Medium aperture MCS utilizing ringed polytetrafluoroethylene (PTFE) grafts safely and reliably prevent recurrent variceal hemorrhage. Encephalopathy is infrequent and mild. This technique preserves the portal venous anatomy making a future OLTx technically easier.
Insights
Medium aperture mesocaval shunts (MCS) effectively prevent variceal bleeding with no mortality. This procedure is safe, preserving liver anatomy for future liver transplants (OLTx).
Area of Science:
- Hepatology
- Surgical Gastroenterology
- Interventional Radiology
Background:
- Partial medium aperture mesocaval shunts (MCS) aim to reduce portal hypertension and prevent variceal hemorrhage.
- The procedure seeks to preserve hepatic portal flow and the porta hepatis for potential liver transplantation (OLTx).
Purpose of the Study:
- To evaluate the safety and efficacy of medium aperture MCS.
- To assess complications, patency, and functional status of MCS in patients requiring portal hypertension management.
Main Methods:
- Retrospective analysis of fifteen patients undergoing partial medium aperture MCS.
- Follow-up period of 21 months to assess outcomes, including complications and shunt patency.
Main Results:
- Zero perioperative and long-term mortality.
- Zero rebleeding rates were observed.
- Early shunt nonfunction occurred in 13% of patients, and mild, medically controlled post-shunt encephalopathy (PSE) was seen in 20%.
Conclusions:
- Medium aperture MCS using ringed polytetrafluoroethylene (PTFE) grafts are safe and effective in preventing recurrent variceal hemorrhage.
- The technique results in infrequent and mild encephalopathy.
- This method preserves portal venous anatomy, simplifying future liver transplantation (OLTx).
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