Abstract
Eighty interposition mesocaval shunts, using a knitted Dacron large diameter prosthesis, have been performed during the past five and one-half years. Patients were evaluated from the standpoint of protection from recurrent esophageal hemorrhage, shunt patency, encephalopathy and cumulative survival analysis. In a selected group of patients, hemodynamic measurements were also obtained in the pre, intra, and postoperative periods. These included measurements of wedged hepatic vein pressure, superior mesentric venous blood flow, and residual superior mesenteric, hepatic sinusoidal and inferior vena cava pressures following the shunt procedure. Additionally, direct shunt flow measurements utilizing a square wave of electromagnetic flowmeter were also performed. Results indicate that the shunt patency is 95%; adequate decompression of the portal system was accomplished; recurrent variceal hemorrhage did not occur if the shunt remained patent; the incidence of encephalopathy was low (11%); and the operative mortality for the entire series was 9%. Continued perfusion of the liver was documented in 44% of patients and appears to be a function of the residual total portal resistance largely controlled by inferior vena caval pressure at the level of graft replacement. Life survivhat the interposition mesocaval shunt appears to be an effective technique for the control of variceal hemorrhage, has important hemodynamic advantages and can be applied to most patients for the control of variceal hemorrhage due to portal hypertension.
Full text
PDFImages in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Barnes B. A., Ackroyd F. W., Battit G. E., Kantrowitz P. A., Schapiro R. H., Strole W. E., Jr, Todd D. P., McDermott W. V., Jr Elective portasystemic shunts: morbidity and survival data. Ann Surg. 1971 Jul;174(1):76–84. doi: 10.1097/00000658-197107010-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bismuth H., Franco D., Hepp J. Portal-systemic shunt in hepatic cirrhosis: does the type of shunt decisively influence the clinical result? Ann Surg. 1974 Feb;179(2):209–218. doi: 10.1097/00000658-197402000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Drapanas T. Interposition mesocaval shunt for treatment of portal hypertension. Ann Surg. 1972 Oct;176(4):435–448. doi: 10.1097/00000658-197210000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Giles G. R., Brennan T. G., Losowsky M. S. Interposition teflon mesenteric caval shunt for bleeding oesophageal varices. Br J Surg. 1973 Aug;60(8):649–652. doi: 10.1002/bjs.1800600818. [DOI] [PubMed] [Google Scholar]
- Grace N. D., Muench H., Chalmers T. C. The present status of shunts for portal hypertension in cirrhosis. Gastroenterology. 1966 May;50(5):684–691. [PubMed] [Google Scholar]
- Jackson F. C., Perrin E. B., Felix W. R., Smith A. G. A clinical investigation of the portacaval shunt. V. Survival analysis of the therapeutic operation. Ann Surg. 1971 Oct;174(4):672–701. doi: 10.1097/00000658-197110000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
- LINTON R. R., ELLIS D. S., GEARY J. E. Critical comparative analysis of early and late results of splenorenal and direct portacaval shunts performed in 169 patients with portal cirrhosis. Ann Surg. 1961 Sep;154:446–459. doi: 10.1097/00000658-196109000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McDermott W. V., Jr Evaluation of the hemodynamics of portal hypertension in the selection of patients for shunt surgery. Ann Surg. 1972 Oct;176(4):449–456. doi: 10.1097/00000658-197210000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Moreno A. H., Burchell A. R., Rousselot L. M., Panke W. F., Slafsky F., Burke J. H. Portal blood flow in cirrhosis of the liver. J Clin Invest. 1967 Mar;46(3):436–445. doi: 10.1172/JCI105545. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Reynolds T. B. The role of hemodynamic measurements in portosystemic shunt surgery. Arch Surg. 1974 Mar;108(3):276–281. doi: 10.1001/archsurg.1974.01350270010003. [DOI] [PubMed] [Google Scholar]
- SCHENK W. G., Jr, McDONALD J. C., McDONALD K., DRAPANAS T. Direct measurement of hepatic blood flow in surgical patients: with related observations on hepatic flow dynamics in experimental animals. Ann Surg. 1962 Sep;156:463–471. doi: 10.1097/00000658-196209000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Salam A. A., Warren W. D., LePage J. R., Viamonte M. R., Hutson D., Zeppa R. Hemodynamic contrasts between selective and total portal-systemic decompression. Ann Surg. 1971 May;173(5):827–844. doi: 10.1097/00000658-197105000-00022. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Smith G. W. An assessment of the validity of preoperative hemodynamic studies in portal hypertension. Surgery. 1973 Jul;74(1):130–138. [PubMed] [Google Scholar]
- Starzl T. E., Francavilla A., Halgrimson C. G., Francavilla F. R., Porter K. A., Brown T. H., Putnam C. W. The origin, hormonal nature, and action of hepatotrophic substances in portal venous blood. Surg Gynecol Obstet. 1973 Aug;137(2):179–199. [PMC free article] [PubMed] [Google Scholar]
- Stipa S., Thau A., Cavallaro A., Rossi P. A technique for mesentericocaval shunt. Surg Gynecol Obstet. 1973 Aug;137(2):285–287. [PubMed] [Google Scholar]
- Thompson B. W., Read R. C. Proceedings: Interposition "H" grafting for protal hypertension. Arch Surg. 1974 Apr;108(4):502–506. doi: 10.1001/archsurg.1974.01350280106017. [DOI] [PubMed] [Google Scholar]
- WARREN W. D., RESTREPO J. E., RESPESS J. C., MULLER W. H. THE IMPORTANCE OF HEMODYNAMIC STUDIES IN MANAGEMENT OF PORTAL HYPERTENSION. Ann Surg. 1963 Sep;158:387–404. doi: 10.1097/00000658-196309000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Warren W. D., Salam A. A., Hutson D., Zeppa R. Selective distal splenorenal shunt. Technique and results of operation. Arch Surg. 1974 Mar;108(3):306–314. doi: 10.1001/archsurg.1974.01350270040008. [DOI] [PubMed] [Google Scholar]