[Hepatic encephalopathy after portosystemic shunt]

A total of 28 cirrhotic patients with porto-systemic anastomosis were compared with 38 cirrhotic patients without porto-systemic shunts concerning their mental state and biochemical parameters of importance for hepatic encephalopathy. A group of 37 metabolically healthy individuals provided the reference values for the psychometric test results and the EEG power spectra. Laboratory values for both groups showed marginal elevation of bilirubin, while the ammonia levels were significantly increased in the operated group. A significant difference was found concerning both the tyrosine level and that of the branched-chain amino acids. None of the patients who had surgical treatment showed clinical evidence of hepatic encephalopathy. Regarding the results in the flicker photometry, the non-shunted cirrhotic patients differed significantly from the healthy control subjects. For both the shunted and non-shunted cirrhotic patients, the results of the Viennese determination test and the number connection test indicated subclinical encephalopathy. We conclude that the elevated ammonia level in patients with porto-systemic anastomosis does not cause a significant mental disturbance. In well-selected patients, the porto-systemic end-side shunt is an appropriate procedure in the treatment of esophageal varices.