Total shunting and elective management of variceal bleeding

Abstract

A 20-year experience with treatment of esophageal varices in patients with cirrhosis is reported. Considering that total shunts are well tolerated immediately after operation (hospital mortality rate for all elective procedures being 6.4%), that they offer a good protection against rebleeding (rebleeding variceal rate of 7.6%), and that they offer the same long-term survival as given by other shunts (5- and 10-year survival rates of 57% and 31%, respectively), the authors affirm that these kinds of shunts are still useful in well selected cases. Late follow-up results of a prospective randomized trial of elective mesocaval shunts compared to portacaval shunt have shown no significant differences in operative mortality, rebleeding rates, encephalopathy rates, or survival. Based on this information, the authors currently use portacaval shunt as their operation of choice.

Portal hypertension and variceal bleeding: An AASLD single topic symposium†

“…Surgical shunts have received renewed interest in the 1990s because of their effectiveness in preventing rebleeding. 96,98,[109][110][111][112][113][114] Bleeding is controlled in 90% to 95% of patients. Data on surgical shunts in the 1990s indicate better outcomes than earlier reported series in the literature primarily because of better patient selection.…”

“…Surgical variceal decompression can be achieved by 1) total portal systemic shunts, which divert all portal flow from the liver, 109,110 2) partial portal systemic shunts, which reduce portal hypertension to 12 mm Hg, and maintain some portal flow in 80% of patients, 111,112,115 or 3) selective variceal decompression (distal splenorenal shunt) which decompresses the spleen and gastroesophageal varices, but maintains portal hypertension. 96,98,113,114,116,117 Data indicate Ն90% control of bleeding with all types of surgical shunt.…”

Effect of coronary-caval shunt combined with partial pericardial devascularisation on oesophageal and gastric variceal bleeding caused by portal hypertension

“…Therefore, it has been almost abandoned in all countries except for China. There are three types of shunting procedures for the treatment of oe- Original Article sophageal and gastric variceal bleeding: total shunt, limited shunt and selective shunt (17). Total shunt and limited shunt operations could relieve portal hypertension effectively.…”

Therapeutic options for endoscopic haemostatic failures: the place of the surgeon and radiologist in gastrointestinal tract bleeding

“…24 Mortality after shunt surgery is high due to the underlying disease and is dependent on the grade of cirrhosis, and could be over 50% in severe cases. 25 Because of these poor results the less invasive TIPS procedure has become the preferred method in reducing portal hypertension and variceal bleeding to obtain haemostasis when endoscopic treatment has failed. Other indications for TIPS include haemorrhage from ectopic varices, which are inaccessible to endoscopy, and congestive gastropathy.…”