Clinical Comparison of End-to-Side and Side-to-Side Portacaval Shunt

Reynolds, Telfer B.; Hudson, Norah M.; Mikkelsen, William P.; Turrill, Fred L.; Redeker, Allan G.

doi:10.1056/nejm196603312741303

Cited by 30 publications

(5 citation statements)

References 10 publications

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“…Chronic hepatic encephalopathy is a common complication of portal-systemic shunting operations (Read, Laidlaw, and Sherlock, 1961;Reynolds, Hudson, Mikkelsen, Turrill, and Redeker, 1966). The syndrome, however, may be observed in patients with chronic liver disease who have not been subjected to a surgical shunt and in this situation one usually finds clinical or radiological evidence of large portal-systemic venous collaterals in the abdomen, ie, a 'natural shunt'.…”

Section: Discussionmentioning

confidence: 99%

Treatment of chronic hepatic encephalopathy with levodopa

Lunzer¹,

James²,

Weinman³

et al. 1974

Gut

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SUMMARY Three of six patients with chronic hepatic encephalopathy treated with levodopa showed a significant improvement. One patient was probably improved whilst the remaining two patients failed to show any benefit. Serial electroencephalography did not demonstrate significant changes. Treatment with levodopa was associated with an improvement in 'speed-based' tasks as assessed by computerized psychometry. A significant rise in cerebral oxygen consumption was found during levodopa therapy. Gastrointestinal side effects were dose limiting. It is concluded that a therapeutic trial of levodopa in patients with chronic hepatic encephalopathy is indicated when the response to conventional therapy has been poor.

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Section: Discussionmentioning

confidence: 99%

Treatment of chronic hepatic encephalopathy with levodopa

Lunzer¹,

James²,

Weinman³

et al. 1974

Gut

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“…The liver may be deprived nutrient arterial flow. A nonrandomized comparison of side-to-side to end-to-side portacaval shunt reported by Reynolds and associates [76,77] demonstrated a higher incidence of post-shunt encephalopathy following a side-to-side shunt.…”

Section: ~D Mmentioning

confidence: 97%

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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“…Interposition between the vena cava and portal or mesenterical vein of an venous auto graft or a teflon or dacron prosthesis [31] has been performed, but this type of procedure has the same significance as that of a side-to-side shunt. End-to-side and side-to-side portacaval shunts have been compared in uncontrolled trials [71,85,95]. These studies and some large published series have shown the following facts: ( I ) total hepatic blood flow decreases more after side-to-side shunt than after end-to-side shunt [72]; (2) wedged hepatic vein pressure-free hepatic vein pressure gradient decreases more after side-to-side shunt than after end-to-side shunt [72]: (3) ascites is more fre quent after end-to-side shunt (5%) than after side-to-side shunt (1%) [60]; (4) hepatic encephalopathy is more frequently observed after side-to-side shunt (30%) than after end-to-side shunt (11%) [71.…”

Section: Choice O F the Type O F Surgical Proceduresmentioning

confidence: 99%

Portal-Systemic Shunts in Patients with Cirrhosis

Rueff¹,

Maillard²

1974

Digestion

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The purpose of this progress report is to make a critical review of the current indications of portal-systemic shunts in cirrhotic patients and to emphasize the necessity (and the difficulties) of controlled clinical trials. The following items were successively studied: (1) portacaval shunt in patients with intractable ascites; (2) prophylactic portacaval shunt; (3) emergency portal-systemic shunts, and (4) elective portal-systemic shunts.

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Clinical Comparison of End-to-Side and Side-to-Side Portacaval Shunt

Cited by 30 publications

References 10 publications

Treatment of chronic hepatic encephalopathy with levodopa

Treatment of chronic hepatic encephalopathy with levodopa

Surgical treatment of portal hypertension: A historical perspective

Portal-Systemic Shunts in Patients with Cirrhosis

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