| Impact of shunt surgery for variceal bleeding in the natural history of ascites in cirrhosis: a retrospective study. | |
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MedLine Citation:
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PMID: 8076916 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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) |
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Authors:
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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:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Hepatology (Baltimore, Md.) Volume: 20 ISSN: 0270-9139 ISO Abbreviation: Hepatology Publication Date: 1994 Sep |
Date Detail:
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Created Date: 1994-10-05 Completed Date: 1994-10-05 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8302946 Medline TA: Hepatology Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 584-91 Citation Subset: IM |
Affiliation:
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Liver Unit, Hospital Clínic i Provincial, University of Barcelona, Spain. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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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