Distal Splenorenal Shunt

Jenkins, Roger L.

doi:10.1001/archsurg.134.4.416

Cited by 43 publications

(6 citation statements)

References 27 publications

(20 reference statements)

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“…However, its selectivity is neither uniform nor durable, and prevalence of HE in the long term has been reported in 9-15% of cases. 1,2,6 …”

Section: Discussionmentioning

confidence: 99%

“…1 Refinement in endoscopic and pharmacological therapies, and more recently, the development of transjugular intrahepatic portosystemic shunt (TIPS) led to a decreased number of patients treated with surgical shunt procedures. 1 However, selective porto-systemic shunting, especially distal splenorenal shunt (DSRS) can be considered for patients with relative preservation of hepatic function, this later is associated with decreased hepatic encephalopathy (HE) and improved survival relative to less selective shunt. 2 Nevertheless, in the long term complications, HE occurs in 9-15%, sometimes refractory to medical treatment.…”

Section: Introductionmentioning

confidence: 99%

“…2 Nevertheless, in the long term complications, HE occurs in 9-15%, sometimes refractory to medical treatment. 1,2 In these cases, modifying porto-systemic shunts are the main therapeutic procedures. 3 Surgical options directed towards the reduction of ammonia production are less common.…”

Section: Introductionmentioning

confidence: 99%

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Colectomy for Porto-Systemic Encephalopathy: Is It Still Topical?

Ennaifer

Hayfa

Hefaiedh

et al. 2013

Clinics and Practice

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Hepatic encephalopathy (HE) is a common long term complication of porto-systemic shunt. We report herein the case of a 59-year-old man with Child-Pugh A cirrhosis treated successfully 9 years earlier with distal splenorenal shunt for uncontrolled variceal bleeding. In the last year, he developed a severe and persistent hepatic encephalopathy secondary to the shunt, which was resistant to medical therapy. As liver transplantation was not available and obliteration of the shunt was hazardous, we performed subtotal colectomy in order to reduce ammonia production. This therapeutic option proved successful, as the grade of encephalopathy decreased and the patient improved. Our experience indicates that colonic exclusion should be considered as an option in the management of HE refractory to medical treatment in highly selected patients when liver transplantation is not available or even as a bridge given the long waiting time on lists.

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“…However, its selectivity is neither uniform nor durable, and prevalence of HE in the long term has been reported in 9-15% of cases. 1,2,6 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Colectomy for Porto-Systemic Encephalopathy: Is It Still Topical?

Ennaifer

Hayfa

Hefaiedh

et al. 2013

Clinics and Practice

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“…40 Postoperative morbidity and mortality is low and excellent control of variceal bleeding and hypersplenism can be achieved. 40,41 Nonselective Shunts Nonselective or central shunts can be used to effectively reduce portal pressure by directly communicating portal system with systemic circulation. While nonselective shunts can provide a significant reduction in portal pressure, this procedure can also result in higher rates of hepatic encephalopathy, a significant problem in children as neurocognitive development may be affected by onset of encephalopathy.…”

Section: Meso-rex Bypass/shuntmentioning

confidence: 99%

An Overview of Surgical Management of Portal Hypertension in Children

Khalil,

Hashimoto

2024

Digestive Disease Interventions

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Pediatric portal hypertension is a relatively rare but a life-threatening problem. With advancements in understanding of portal hypertension physiology and lessons learned from management in adults, medical management is playing an increasing role. However, certain conditions are amenable to surgical management. Key considerations for surgical options are state of liver parenchyma and preservation of liver function. In cases of extrahepatic portal vein obstruction, Meso-Rex bypass or shunt can offer a long-term solution. Similarly in select group of patients, selective or central shunts can be considered. With advancement in liver transplantation, there are very few indications for non-transplant surgical procedures for the management of portal hypertension.

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“…[ 6 ] Recent article reported that patients receiving DSRS would have significantly lower rebleeding and encephalopathy rates than TIPS in the management of refractory variceal bleeding. [ 7 ] Also, PCS was reported significantly superior to endoscopic therapy in a longer survival rate, less morbidity and lower direct and indirect costs. [ 8 ] With more randomized controlled trials (RCTs) comparing TIPS with surgical shunting undertaken, the optimal management for patients with portal hypertension can be tested.…”

Section: Introductionmentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt Versus Surgical Shunting in the Management of Portal Hypertension

Huang

Zhang

et al. 2015

Chinese Medical Journal

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Background:The purpose of this article was to clarify the optimal management concerning transjugular intrahepatic portosystemic shunts (TIPSs) and surgical shunting in treating portal hypertension.Methods:All databases, including CBM, CNKI, WFPD, Medline, EMBASE, PubMed and Cochrane up to February 2014, were searched for randomized controlled trials (RCTs) comparing TIPS with surgical shunting. Four RCTs, which were extracted by two independent investigators and were evaluated in postoperative complications, mortality, 2- and 5-year survival, hospital stay, operating time and hospitalization charges.Results:The morbidity in variceal rehemorrhage was significantly higher in TIPS than in surgical shunts (odds ratio [OR] = 7.45, 95% confidence interval[CI]: (3.93–14.15), P < 0.00001), the same outcomes were seen in shunt stenosis (OR = 20.01, 95% CI: (6.67–59.99), P < 0.000001) and in hepatic encephalopathy (OR = 2.50, 95% CI: (1.63–3.84), P < 0.0001). Significantly better 2-year survival (OR = 0.66; 95% CI: (0.44–0.98), P = 0.04) and 5-year survival (OR = 0.44; 95% CI: (0.30–0.66), P < 0.00001) were seen in patients undergoing surgical shunting compared with TIPS.Conclusions:Compared with TIPS, postoperative complications and survival after surgical shunting were superior for patients with portal hypertension. Application of surgical shunting was recommended for patients rather than TIPS.

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Distal Splenorenal Shunt

Cited by 43 publications

References 27 publications

Colectomy for Porto-Systemic Encephalopathy: Is It Still Topical?

Colectomy for Porto-Systemic Encephalopathy: Is It Still Topical?

An Overview of Surgical Management of Portal Hypertension in Children

Transjugular Intrahepatic Portosystemic Shunt Versus Surgical Shunting in the Management of Portal Hypertension

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