A Controlled Study of Therapeutic Portacaval Shunt in Alcoholic Cirrhosis

Rueff, B; Degos, Françoise; Degos, J D; Maillard, J N; Prandi, D; Sicot, J.; Sicot, C; Fauvert, R; Benhamou, Jean‐Pierre

doi:10.1016/s0140-6736(76)92775-6

Cited by 153 publications

(29 citation statements)

References 12 publications

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“…22 Despite the effectiveness of portacaval shunting in controlling variceal hemorrhage, its efficacy in prolonging survival has been clearly disclaimed in three prospective randomized studies. [23][24][25] These controlled studies have shown that patients with shunts die of liver failure while the medically treated patients succumb to bleeding. Indeed, the incidence of hepatic encephalopathy was approximately equal in the medically and surgically treated groups.…”

Section: Discussionmentioning

confidence: 99%

Warren shunt - significance in present time, an experience at tertiary care hospital in India

et al. 2016

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INTRODUCTIONPortal hypertension is the presence of portal venous pressure more than 10 mm Hg. Esophagogastric varices do not bleed until portal pressure exceeds 12 mm Hg, and then they bleed in only one third to one half of patient. 1Portal hypertension was recognized by the Greeks and was highlighted by Shakespeare in his character of Falstaff.2,3 Surgery was the only treatment available for portal hypertension in the earlier times and the mortality rates were very high. In present times, about 10-15% of patients require surgery. With the development of the endoscopic treatment i.e. sclerotherapy, surgery no longer remains the first line of treatment in portal hypertension.Shunts have been attempted since 1877 wherein Eck ligated the portal vein and connected the visceral end to the vena cava. It commonly became known as Eck Fistula.4 Nicolai Eck was a Russian Army surgeon and performed an end-to-side portocaval shunt in an animal model. Vidal, a French surgeon is credited with performing the first portal systemic shunt in man in 1903. In mid-1940's a portocaval shunt was devised by Whipple and Blakemore and many other procedures were tried as mesocaval shunts by Drapanas, selective variceal decompression by Warren and Inochuchi and partial shunts by Sarfeh. [5][6][7][8][9] First sclerotherapy was done with rigid oesophagoscope. In the 1980s, three surgeons Johnston, Terblanche and Paquet turned from rigid to ABSTRACT Background: Portal hypertension is the presence of portal venous pressure more than 10 mm Hg. Surgery was the only treatment available for portal hypertension in the earlier times and the mortality rates were very high. In present times, about 10-15% of patients require surgery. Here we study the significance of the distal splenorenal shunt (Dean Warren shunt). Methods: We studied a total of 45 patients of portal hypertension admitted at SSKM Hospital, IPGMER, Kolkata, over a period of 5 years. This study includes the patients, ranging in age from 5 to 20 years and comprising of 5 women and 40 men. All patients were having non cirrhotic extra-hepatic portal. Results: All of the patients survived postoperatively and are in follow-up without any complication and doing well. Conclusions: Warren's shunt is a good alternative of liver transplantation, especially for the developing countries where the facilities for liver transplantation and post-operative care are not available or good enough. It has very good results and low complication rates.

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Section: Discussionmentioning

confidence: 99%

Warren shunt - significance in present time, an experience at tertiary care hospital in India

et al. 2016

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“…The evidence for this is com pelling. First, PHG does not occur in patients who have undergone portal decompressive surgery [51][52][53]. Second, portal-systemic shunt surgery appears to be effective in the management of diffuse gastric mucosal bleed ing secondary to severe PHG [54], Finally, PHTN may be responsible at least in part for the stasis and congestion observed in such patients.…”

Section: Portal Hypertensionmentioning

confidence: 99%

Portal Hypertensive Gastropathy

Trevino

Brady²,

Schenker

1996

Dig Dis

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Portal hypertensive gastropathy (PHG) is part of a complex syndrome which occurs as a complication of chronic liver disease and portal hypertension (PHTN). At endoscopy, the gastric mucosa shows that mosaic-like pattern and red marks, which are the source of gastric bleeding. Only the severe form of gastropathy is liable to bleed. The pathogenesis of PHG and the hemodynamic changes in PHTN are not completely understood, but chronic increase in portal pressure is a prerequisite for the development of this disorder. It has been suggested that an overproduction of endogenous vasodilators and a reduced vascular sensitivity to endogenous vasoconstrictors contribute to these circulatory disturbances. H₂ receptor antagonists and sucralfate are ineffective in the management of bleeding PHG. Two small studies reported that propranolol is effective in arresting mucosal hemorrhage from severe PHG. Other feasible alternatives include transjugular intrahepatic portal-systemic shunt (TIPS) and portal-systemic shunt procedure.

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“…Portosystemic shunt procedures can effectively decompress the portal bed and have been shown to reduce the frequency of reblecding [8], Unfortunate ly, this benefit occurs at the expense of an increased incidence of portosystemic enceph alopathy and death from hepatic failure. Early controlled trials have shown that pro phylactic portosystemic shunts for cirrhotic patients with varices offered no benefit over medical therapy [5,9,10], In addition, four prospective, randomized controlled trials comparing therapeutic portosystemic shunt with medical therapy in patients with cirrho sis and variceal hemorrhage have failed to show a statistically significant prolongation in survival in the surgically treated groups [8,[11][12][13], Warren et al [14] introduced the distal splenorenal shunt in 1967, which has been shown to equal conventional shunts in con trolling recurrent bleeding, but has a lower incidence of postshunt encephalopathy [ 15,16]. However, Conn et al [17] in a prospec tive, controlled study comparing results of the distal splenorenal shunt with conven tional systemic shunts found no difference in rate of encephalopathy, shunt occlusion, or recurrent hemorrhage.…”

Section: Treatment Of Variceal Hemorrhagetherapeutic Optionsmentioning

confidence: 99%