Selective shunts: The Johannesburg experience
| Autor: | J. Albertus Myburgh |
|---|---|
| Rok vydání: | 1990 |
| Předmět: |
Liver Cirrhosis
Alcoholic liver disease medicine.medical_specialty business.industry medicine.medical_treatment Encephalopathy Significant difference Splenectomy General Medicine medicine.disease Actuarial survival Surgery Liver Cirrhosis Alcoholic Recurrence Hypertension Portal medicine Humans Portal hypertension Emergencies business Perfusion Splenorenal Shunt Surgical Shunt (electrical) |
| Zdroj: | The American Journal of Surgery. 160:67-74 |
| ISSN: | 0002-9610 |
| DOI: | 10.1016/s0002-9610(05)80871-2 |
| Popis: | My personal 15-year experience with 141 selective shunts (127 elective, 14 emergency) for portal hypertension is reported. Alcoholic cirrhosis comprised 54% of elective operations, and of the nonalcoholic patients, 22% were cirrhotic and 24% were noncirrhotic. Adequate and, if necessary, prolonged (mean 6 weeks) in-hospital preparation resulted in Hospital mortality and long-term actuarial survival were better in nonalcoholics compared with alcoholics, but there was no significant difference between cirrhotic nonalcoholics and alcoholics. Variceal rebleeding was rare (4% of Warren procedures) and, when present, was usually related to shunt failure. Gastric fundal variceal rebleeding did not occur in 44 patients undergoing splenopancreatic disconnection. Postoperative encephalopathy occurred in 13% of patients; however, it did not occur at all in noncirrhotic patients. Prograde portal venous perfusion was preserved in 77% of patients. Fifteen alternate selective operations to the Warren shunt were performed, usually because of antecedent splenectomy. Shunt failure and variceal rebleeding occurred more frequently with these more vulnerable shunts, but 66% had a satisfactory outcome. Selective shunts have produced highly satisfactory results in appropriately selected patients. |
| Databáze: | OpenAIRE |
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