Document Detail

Selective variceal decompression and its role relative to other therapies.
MedLine Citation:
PMID:  2368877     Owner:  NLM     Status:  MEDLINE    
Seventy patients, selected from 265 patients with proved variceal bleeding, underwent a distal splenorenal shunt (DSRS) procedure with or without splenopancreatic disconnection (SPD). Alcoholic cirrhosis was the cause of portal hypertension in 57% of the patients. The operative mortality was 13% (Child's classes A and B 2%, class C 66%). Despite fewer varices in all of the patients, variceal rebleeding and death occurred in one patient (2%). Late portal perfusion was observed in 91% of the patients, with worsening in 23%, compared with the preoperative study. Persistent hepatocyte necrosis and incomplete SPD were the most significant prognostic factors for decreased perfusion (presence and absence of necrosis, 38% and 12%, respectively; DSRS and DSRS with SPD, 43% and 12%, respectively). SPD also decreased ongoing hepatocyte damage. Post-shunt encephalopathy was clinically evident in 7% of the patients, but after electroencephalographic evaluation, it increased to 24.6%. Significant factors in its development included decreased portal perfusion (62% versus 14%), active hepatitis (48% versus 17%), and incomplete SPD (43% versus 14%). The higher late liver-related mortality was associated with a lack of or decreased portal perfusion and the absence of SPD.
A Maffei-Faccioli; G E Gerunda; D Neri; R Merenda; F Zangrandi; F Meduri
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of surgery     Volume:  160     ISSN:  0002-9610     ISO Abbreviation:  Am. J. Surg.     Publication Date:  1990 Jul 
Date Detail:
Created Date:  1990-08-16     Completed Date:  1990-08-16     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  60-6     Citation Subset:  AIM; IM    
Institute of Second Surgical Pathology, University of Padova, Italy.
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MeSH Terms
Esophageal and Gastric Varices / complications,  mortality,  surgery*
Gastrointestinal Hemorrhage / etiology,  surgery*
Hepatic Encephalopathy / etiology
Middle Aged
Postoperative Complications
Splenorenal Shunt, Surgical* / adverse effects,  methods

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