Prophylactic Portacaval Anastomosis in Cirrhotic Patients with Esophageal Varices

Conn, Harold O.; Lindenmuth, W. W.

doi:10.1056/nejm196810032791401

Cited by 56 publications

(3 citation statements)

References 23 publications

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“…Consequently, a study of the prophylactic shunt was initiated, as later reported by Resnick and the group [92]. This study, as well as a concurrent study of prophylactic shunt by Corm and Lindenmuth of Yale [93], established that a portacaval shunt did not reduce mortality or favorably influence the clinical course of cirrhotics that had never bled and that had varices.…”

Section: ~D Mmentioning

confidence: 95%

Surgical treatment of portal hypertension: A historical perspective

Donovan

1984

World j. surg.

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Portal hypertension has been treated surgically by diversion of blood from the portal system, by interruption of the flow of blood to esophageal varices, or by direct obliteration of the varices. At the beginning of the twentieth century, portal diversion was achieved by omentopexy and, in a few patients, by the creation of a portacaval shunt. The latter operation was abandoned because of high mortality and morbidity rates, including shunt encephalopathy. In the 1940's, interest was renewed in the portacaval shunt. Improved understanding of hepatic physiology and the establishment of precise criteria for selection of cases for surgery resulted in a low operative mortality rate. The operation was highly successful in the control of hemorrhage from esophageal varices but was associated with an undesirable incidence of impairment of hepatic function. Currently, selective decompression of varices by the distal splenorenal shunt is under evaluation as a method of preventing variceal hemorrhage, while preserving hepatic function. Elimination of the threat of hemorrhage from varices by arterial ligation, sclerotherapy, or direct suture has been practiced for almost a century. The result remains one of temporary control with recurrent hemorrhage in the majority of cases.Ascites was formerly considered the dominant manifestation of portal hypertension. Currently, it is usually well controlled by diuretics. Surgery is reserved for the rare case of intractable ascites, often with hepatorenal syndrome. In such cases, a shunt is established between the peritoneal cavity and the systemic venous system, a procedure first performed early in this century.

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Section: ~D Mmentioning

confidence: 95%

Surgical treatment of portal hypertension: A historical perspective

Donovan

1984

World j. surg.

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“…3). By the end of the 1960s it became apparent that portasystemic encephalopathy was a common complication after portasystemic decompression shunts, and these shunt operations neither favor the survival of the patients nor improve their quality of life [17]. Table 1 shows the results of Kimoto's clinic at the University of Tokyo (Table 1).…”

Section: Portal Hypertension: Shunt Operationsmentioning

confidence: 99%

Progress and Changes in Surgery: Portal Hypertension

Idezuki

President²,

Sic³

1998

World j. surg.

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“…As experience has accumulated with total shunted patients, it has become evident that certain individuals tolerate the procedure poorly and many suffer major morbidity or decreased survival when compared with nonshunted cirrhotics. Results of controlled, randomized studies from Boston and New Haven demonstrated clearly that there was no advantage to "prophylactic" portacaval shunts, as any potential increased survival resulting from prevention of variceal hemorrhage was more than offset by an increased rate of postoperative hepatic failure (4,5). Other studies have suggested that even in patients undergoing "therapeutic" shunts, the five-year survival is not significantly different between surgical and nonsurgical populations.…”

Section: Introduction +7145mentioning

confidence: 99%

Selective Distal Splenorenal Shunt for Bleeding Esophageal Varices

Wd¹

1975

Annu. Rev. Med.

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The selective distal splenorenal shunt has been shown to be equally as effective as total portal-systemic shunting procedures in the control of variceal hemorrhage and it can now be performed with an equivalent operative mortality. It is superior to other shunts in metabolic aspects and results in a markedly decreased incidence of postoperative hepatic encephalopathy. Massive ascites constitutes a definite contraindication to the selective distal splenorenal anastomosis, but for all other suitable patients this procedure appears to be the optimal method of surgical management at this time.

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Prophylactic Portacaval Anastomosis in Cirrhotic Patients with Esophageal Varices

Cited by 56 publications

References 23 publications

Surgical treatment of portal hypertension: A historical perspective

Surgical treatment of portal hypertension: A historical perspective

Progress and Changes in Surgery: Portal Hypertension

Selective Distal Splenorenal Shunt for Bleeding Esophageal Varices

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