A Clinical Investigation of the Portacaval Shunt

Jackson, Francis C.; Perrin, Edward B.; Felix, W; Smith, Anajane G.

doi:10.1097/00000658-197110000-00012

Cited by 220 publications

(9 citation statements)

References 13 publications

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“…The same propensity to recurrent hemorrhage in patients who had bled before was seen in the two VA Cooperative Studies [59,60] as well as in the prophylactic shunt studies done by Conn et al [57]. Similarly, the prognosis was worse in patients in the therapeutic studies than in those in prophylactic shunt studies, for cumulative survival curves showed mortality to be lower in the control group of each prophylactic shunt study than of each of the therapeutic shunt studies.…”

Section: Therapeutic Portacaval Anastomosismentioning

confidence: 52%

“…It would appear that end-to-side portacaval shunt including its several variations is not the therapeutic final solution; that although this form of therapy appears to improve survival in a group of heterogeneous cirrhotic patients limited to those who share in common one or more previous episodes of variceal hemorrhage, it does so at the price of total diversion of portal flow away from the liver and is thereby associated with a high frequency of encephalopathy. One would prefer to restrict this operation to those patients who are destined to bleed from varices again, "and who are not subject to the same risks of the 30-40% of the survivors of their first variceal hemorrhage who never again bleed from varices [58,59,61]. "…”

Section: Discussionmentioning

confidence: 99%

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Portacaval shunts

Callow

1984

World j. surg.

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Although portacaval shunt has been amply demonstrated as providing effective therapy for the control of bleeding varices, it produces total diversion of portal flow with a high incidence of hepatic failure which, if not fatal, is frequently associated with encephalopathy. Various modifications of the portacaval shunt, physiologically a central shunt, are associated with the same immediate and delayed negative side effects as the standard end‐to‐side portacaval shunt. Numerous therapeutic modifications intended to lessen the incidence and severity of post‐shunt encephalopathy, such as limitation of protein intake, antibiotics, normalization of plasma amino acids, and modification of the gastrointestinal flora, are largely unsuccessful. Trials of adjuvant procedures such as arterialization of the portal vein and colon exclusion, as well as attempts to reduce the mortality rate of the first variceal hemorrhage by either prophylactic shunt or emergency portacaval shunt, have produced disappointing results in most instances. End‐to‐side portacaval shunt is not the therapeutic final solution. It may be indicated in the patient with intractable or severe ascites, in the presence of massive uncontrolled hemorrhage (an emergency situation), and to a very limited extent, in the presence of a few otherwise uncontrollable metabolic diseases such as hyperlipidemia. Ideally, one would prefer to restrict this operation to those patients who are destined to bleed from varices again.

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Section: Therapeutic Portacaval Anastomosismentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Portacaval shunts

Callow

1984

World j. surg.

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“…Although most authorities have accepted that there is a need to treat patients who have had a variceal bleed, one alternative that must be considered today is to manage such patients expectantly and treat recurrent variceal bleeds, when they occur, along the lines already indicated. This policy is supported by the data from recent controlled clinical trials, comparing therapeutic portacaval shunting with conservative medical management, as they have not shown significantly increased survival in the shunted patients (Jackson et al 1971, Resnick et al 1974, Rueff et al 1976).…”

Section: Treatment Of 41r4 L Oesophageal Varicesamentioning

confidence: 86%

Treatment of Oesophageal Varices

Terblanche

1979

J R Soc Med

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“…With the prophylactic shunt dis-credited, the value of therapeutic shunts (in patients who had already bled from demonstrable esophageal varices) was reexamined, and RCT's were finally deemed necessary and appropriate (8).…”

Section: Shunt Surgery For Portal Hypertensionmentioning

confidence: 99%

Surgical Innovation and Its Evaluation

Jp¹,

Hinkley²,

McDermott³

1978

Science

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Early clinical trials, observational or randomized, hasten the prompt evaluation of new operations. Early clinical surveillance facilitates the design and implementation of randomized clinical trials when they are necessary. Of equal or greater importance, long-term surveillance of operations allows continuing evaluation when their use becomes widespread. Standards, coordination, review, and funding of the evaluation of new operations we believe should be centralized in a single national agency, for which an Institute of Health Care Assessment might be created. Implementation and regulation of the evaluation we believe should remain at the local or regional level with existing mechanisms and agencies being used, such as institutional human research committees and local health systems agencies.

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A Clinical Investigation of the Portacaval Shunt

Cited by 220 publications

References 13 publications

Portacaval shunts

Portacaval shunts

Treatment of Oesophageal Varices

Surgical Innovation and Its Evaluation

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