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Distal splenorenal shunt versus 10-mm low-diameter mesocaval shunt for variceal hemorrhage
M A Mercado1, J C Morales-Linares, J Granados-García
1Portal Hypertension Clinic, Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City, D.F. Mexico.
Background:
Portal hypertension surgery remains a good therapeutic choice for well selected patients with variceal bleeding. The distal splenorenal shunt (DSRS) has shown good long-term results and low-diameter shunts have emerged as an alternate choice.
Methods:
A prospective, controlled and not randomized study was designed to compare the DSRS (23 patients) and the low-diameter 10 mm ring reinforced PTFE mesocaval shunt (LDMCS) (22 patients) in low-risk electively operated patients (Child-Pugh A-B). The operation was selected according to the anatomical status of the veins.
Results:
Both groups were comparable. No differences were observed regarding rebleeding, operative mortality and survival. Significative differences were observed regarding encephalopathy and shunt thrombosis (higher in the LDMCS). Postoperative angiography showed better maintenance of portal blood flow in the DSRS group.
Conclusions:
Both operations are adequate alternatives for the elective treatment of portal hypertension in low-risk patients. However, the DSRS has more advantages than the LDMCS.