The distal splenorenal shunt (DSRS) was compared with the side-t-side portacaval shunt (PCS) in 93 prospectively matched cirrhotic patients with portal hypertension. After a mean follow-up of 38 months, no differences were observed in operative mortality, long term survival and variceal rebleeding between the two groups. There was no significant difference in terms of acute encephalopathy (22% in PCS group and 33% in DSRS group) and chronic encephalopathy (35% in PCS and 17% in DSRS). However, the only cases of severe and disabling chronic encephalopathy (CE) arose after PCS (p = 0.049). Actuarial curves of CE showed that the maximum rate of this complication (18%) in the DSRS group was reached 27 months after shunt surgery, whereas this value was reached and passed in PCS group only 4 months after shunt. CE occurred for a total duration of 20.1 months after PCS and only 11.1 months after DSRS (p = 0.003) and occupied 46.3% of the follow-up of PCS patients in contrast to 18.7% of the follow-up of DSRS patients (p = 0.001). DSRS is associated with a lower global incidence of CE without severe forms and provides a better quality of life than does a nonselective shunt.

[Clinical results of selective distal splenorenal and latero-lateral portacaval anastomoses. Comparative prospective study of 93 patients] / G. Pezzuoli, G. P. Spina, F. Galeotti, E. Opocher, R. Santambrogio, G. Gagliano, M. Strinna. - In: ANNALES DE CHIRURGIE. - ISSN 0003-3944. - 45:4(1991), pp. 344-349.

[Clinical results of selective distal splenorenal and latero-lateral portacaval anastomoses. Comparative prospective study of 93 patients]

E. Opocher;
1991

Abstract

The distal splenorenal shunt (DSRS) was compared with the side-t-side portacaval shunt (PCS) in 93 prospectively matched cirrhotic patients with portal hypertension. After a mean follow-up of 38 months, no differences were observed in operative mortality, long term survival and variceal rebleeding between the two groups. There was no significant difference in terms of acute encephalopathy (22% in PCS group and 33% in DSRS group) and chronic encephalopathy (35% in PCS and 17% in DSRS). However, the only cases of severe and disabling chronic encephalopathy (CE) arose after PCS (p = 0.049). Actuarial curves of CE showed that the maximum rate of this complication (18%) in the DSRS group was reached 27 months after shunt surgery, whereas this value was reached and passed in PCS group only 4 months after shunt. CE occurred for a total duration of 20.1 months after PCS and only 11.1 months after DSRS (p = 0.003) and occupied 46.3% of the follow-up of PCS patients in contrast to 18.7% of the follow-up of DSRS patients (p = 0.001). DSRS is associated with a lower global incidence of CE without severe forms and provides a better quality of life than does a nonselective shunt.
Portacaval Shunt, Surgical; Hepatic Encephalopathy; Prospective Studies; Humans; Gastrointestinal Hemorrhage; Esophageal and Gastric Varices; Middle Aged; Liver Cirrhosis; Splenorenal Shunt, Surgical; Male; Female
Settore MED/18 - Chirurgia Generale
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/180918
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