Document Detail


Impact of shunt surgery for variceal bleeding in the natural history of ascites in cirrhosis: a retrospective study.
MedLine Citation:
PMID:  8076916     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Despite the efficacy of shunt surgery in the treatment of variceal bleeding, less effective nonoperative therapies are being substituted because surgical shunt does not modify survival and increases hepatic encephalopathy. However, the real impact of shunt surgery on the natural history of ascites and its complications has not been established. The course of 204 Child-Pugh A and B cirrhotic patients with variceal bleeding included in three controlled trials of our units who survived first hospitalization was updated. Ninety-eight patients (group I) were treated by portacaval (56 patients) or distal splenorenal (42 patients) shunt, whereas 106 (group II) were treated by nonshunt procedures (sclerotherapy in 89 patients and staple transection in 17 patients). As expected, the 5-yr probability of variceal rebleeding was lower (13% vs. 44%) and hepatic encephalopathy higher (50% vs. 28%) in group I than in group II, and survival was similar (67% vs. 60%). Shunt surgery had a great impact on the natural history of ascites and its complications. The probability of occurrence of ascites (15% vs. 73%; p < 0.0001), spontaneous bacterial peritonitis (2% vs. 21%; p < 0.0001) and hepatorenal syndrome (4% vs. 21%; p < 0.01) was greatly reduced. These beneficial effects accounted for the lower percentage patients requiring readmissions (51% vs. 70%; p = 0.02) and shorter total time spent in hospital (14 +/- 22 vs. 26 +/- 39 days/patient; p = 0.01) in group I. These data indicate that shunt surgery, in addition to reducing the probability of rebleeding, markedly decreases the probability of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome development.(ABSTRACT TRUNCATED AT 250 WORDS)
Authors:
A Castells; J Saló; R Planas; J C Quer; A Ginès; J Boix; P Ginès; M A Gassull; J Terés; V Arroyo
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Hepatology (Baltimore, Md.)     Volume:  20     ISSN:  0270-9139     ISO Abbreviation:  Hepatology     Publication Date:  1994 Sep 
Date Detail:
Created Date:  1994-10-05     Completed Date:  1994-10-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8302946     Medline TA:  Hepatology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  584-91     Citation Subset:  IM    
Affiliation:
Liver Unit, Hospital Clínic i Provincial, University of Barcelona, Spain.
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MeSH Terms
Descriptor/Qualifier:
Adult
Ascites / etiology*
Bacterial Infections / etiology
Female
Hemorrhage / etiology*,  mortality,  surgery*
Hepatic Encephalopathy / etiology
Hepatorenal Syndrome / etiology
Humans
Liver Cirrhosis / complications*
Male
Middle Aged
Patient Readmission
Peritonitis / microbiology
Portacaval Shunt, Surgical*
Postoperative Complications
Recurrence
Retrospective Studies
Splenorenal Shunt, Surgical*
Survival Analysis
Varicose Veins / complications*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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