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Related Experiment Videos

Changing pattern of portasystemic shunt surgery

J A van der Vliet1, E de Visser, F G Buskens

  • 1Department of Surgery, St. Radboud University Hospital, Nijmegen, Netherlands.

The European Journal of Surgery = Acta Chirurgica
|December 1, 1995
PubMed
Summary

Portasystemic shunt surgery has declined, with increased emergency operations and high mortality, especially in severe liver disease. Survival is poor in alcoholic cirrhosis, and encephalopathy is common post-surgery.

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Area of Science:

  • Surgical procedures
  • Gastroenterology
  • Hepatology

Background:

  • Portasystemic shunts are used to treat portal hypertension and variceal hemorrhage.
  • The pattern of portasystemic shunt surgery has evolved due to advancements in alternative treatments.

Purpose of the Study:

  • To analyze changes in the pattern of portasystemic shunt surgery over a 15-year period.
  • To evaluate the outcomes of portasystemic shunt surgery, including mortality, survival, and encephalopathy.

Main Methods:

  • Retrospective study at a single university hospital.
  • Analysis of 74 patients who underwent portasystemic shunts.
  • Data collected on disease severity, operation type, early mortality, long-term survival, and encephalopathy.

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Main Results:

  • A decline in the overall number of portasystemic shunts, with a rise in emergency operations.
  • Early mortality rates varied significantly with disease severity (Child A: 3%, Child B: 7%, Child C: 56%).
  • Five-year survival was 77% for Child A, 58% for Child B, and 11% for Child C; survival was lower in alcoholic liver cirrhosis. Postoperative encephalopathy occurred in 22% of patients.

Conclusions:

  • The pattern of portasystemic shunt surgery has shifted, with a constant rate of acute operations despite declining elective procedures.
  • Liver disease severity and alcoholic cirrhosis are critical determinants of long-term survival.
  • Postoperative encephalopathy is a frequent complication, independent of shunt technique; elective procedures should preserve options for future liver transplantation.