Splenorenal Shunt

Abstract

Hypothesis: Splenorenal shunt, an accepted treatment to prevent recurrent variceal bleeding, is an ideal procedure for patients with psychosocial issues or limited access to tertiary medical centers. Methods:We retrospectively reviewed the medical records of 34 patients (32 distal splenorenal shunts and 2 central splenorenal shunts) treated from January 1, 1995, through December 31, 2001, for demographic data, substance abuse status, psychosocial factors, previous treatments, Child class, length of hospital stay, operative transfusions, complications, and outcome.Results: Of the 34 patients, 17 were from surrounding Pacific islands (as many as 3800 miles away from Honolulu, Hawaii). Sixteen patients were Child class A, and 18 were Child class B. Twenty-four patients were either homeless, actively involved in substance abuse, or being treated for psychiatric problems, and 20 patients were either uninsured or insured by third-party payers that did not cover liver transplantation. Four patients underwent distal splenorenal shunt for a failed transjugular intrahepatic portosystemic shunt. Patients received a mean of 1.3 U of packed red blood cells (range, 0-5 U), and 15 received no blood transfusions. Mean length of hospital stay was 12.7 days (9 days postoperatively). Perioperative mortality was 8.8%. Three patients rebled postoperatively, 2 because of gastric ulcers and 1 because of an inadequate shunt. The 1-year survival rate was 95% in the 20 patients for whom data were available.Conclusions: Splenorenal shunt is an important treatment for noncompliant patients or patients living in remote areas where access to specialized treatments, such as endoscopy, transjugular intrahepatic portosystemic shunt, ultrasonography, and liver transplantation, is limited. We can achieve acceptable morbidity and mortality in this group of patients, although follow-up can be difficult.

A scoping review of surgical care for people experiencing homelessness: prevalence, access, and disparities

“…Many studies discussed barriers or challenges PEH face when it comes to surgical care, including 48 primary studies, 19 , 31 , 34 – 36 , 39 – 41 , 43 – 45 , 47 – 50 , 54 , 55 , 57 – 64 , 66 , 69 , 72 , 73 , 75 , 79 – 81 , 86 , 91 , 96 , 98 , 100 , 102 – 105 , 107 – 109 , 111 , 112 , 114 , 116 9 abstracts, 37 , 38 , 42 , 52 , 77 , 84 , 101 , 106 , 118 5 literature reviews, 22 , 74 , 95 , 99 , 110 1 invited article, 51 1 magazine article, 70 1 thought piece, 92 1 ethical essay, 115 1 thesis, 71 and 1 historical analysis. 117 The majority of comments presented concerns regarding living conditions.…”

“… 22 , 43 , 49 , 51 , 59 , 73 , 74 , 84 , 100 , 108 – 110 Specifically, 11 studies commented on challenges for PEH accessing specialty care. 36 , 41 , 43 , 60 , 75 , 92 , 99 , 100 , 103 , 111 , 112 Four studies mentioned their overreliance on visits to the emergency department. 41 , 75 , 95 , 103 Two studies commented on how a hospital’s limited funding, resources, space, and personnel can prevent PEH from receiving the care they need while admitted, 30 , 47 and 1 study commented on how PEH can experience more discharge concerns.…”

“…Many studies discussed barriers or challenges PEH face when it comes to surgical care, including 48 primary studies, 19,31,[34][35][36][39][40][41][43][44][45][47][48][49][50]54,55,[57][58][59][60][61][62][63][64]66,69,72,73,75,[79][80][81]86,91,96,98,100,[102][103][104][105][107][108][109]111,112,114,116 9 abstracts, 37,38,42,…”