The Comparative Survivals of Alcoholics Versus Nonalcoholics After Distal Splenorenal Shunt

Abstract

Survival after distal splenorenal shunt in appreciably better in nonalcoholic patients than in alcoholics. This increase in survival does not appear to be dependent upon the state of biochemical liver function or the severity of changes in liver histology since these latter were similar for both groups. We suggest that the poorer survival of alcoholics may be related to continuing alcohol toxicity, and that a possible reason for the failure to demonstrate this difference in survival after portacaval shunts may be due to the harmful effects of total portal diversion on the liver.

Early Variceal Rebleeding After Successful Distal Splenorenal Shunt

“…Some authors have suggested that variceal rebleeding after DSRS occurs only if the shunt becomes occluded. 21 However, several recent reports of variceal rebleeding after successful DSRS have been published in the surgical liter¬ ature.5"8 The true incidence of this unexpected complication is difficult to ascertain, but based on our experience it may be higher than previously thought.…”

Survival of Alcoholic v Nonalcoholic Patients After Portasystemic Shunts

“…They concluded that continued excessive ethyl alcohol ingestion has an important role in decreased alcoholic survival. 2 Continued ethyl alcohol ingestion has also been sug¬ gested by Reynolds et al7 to be detrimental to long-term survival after shunting. In their randomized study that compared end-to-side portacaval shunts with medical ther¬ apy in alcoholic cirrhotic patients, they found that the majority of long-term survivors at 60 months who were clinically well were thought to be abstainers.…”

Distal Splenorenal Shunt – Premise, Perspective, Practice

“…While most series show no substantial survival advantage conferred by the DSRS. two non-randomized trials have suggested that in non-alcoholic cirrhotics, the long-term survival following DSRS is significantly better than that following total shunts [23][24][25] among alcoholic patients, the shunt-related survival differences appear insignificant.…”