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Background. This study evaluated the effectiveness of distal (DSRS) versus the central or proximal (PSRS) splenorenal shunts in the elective treatment of bleeding varices.
Methods. A series of 48 patients with portal hypertension and established variceal bleeding mere randomized to undergo PSRS or DSRS. Preoperative evaluation included endoscopic examination, angiography, serum amino acid profile, liver chemistry studies, and neurologic evaluation. Any patient with significant ascites and hepatofugal flow underwent PSRS shunt procedures; the remainder were randomized prospectively.
Results. Between 1979 and 1989, 29 patients underwent PSRS and 19 underwent DSRS. The mean length of follow-up was 48 months. The groups were equivalent with regard to age, gender, Child's class, number of preoperative bleeds, and cause of disease. No difference was found in any of the factors measured. In particular there were no differences in the operative mortality rate (17% PSRS; 11% DSRS), 5-year survival rate (52% PSRS; 52% DSRS), rebleeding (34% PSRS; 32% DSRS), shunt occlusion (7% PSRS; 11% DSRS), development of individual episodes of postoperative encephalopathy (28% PSRS; 26% DSRS), chronic postoperative encephalopathy (17% PSRS; 11% DSRS), or mean branched-chain/aromatic amino acid ratios (PSRS = 0.88 ± 0.05; DSRS = 0.66 ± 0.05).
Conclusions. The results do not support the contention that DSRS is associated with either greater survival or less encephalopathy than PSRS.
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- Prospective comparative trial with distal splenorenal and mesocaval shunts.Am J Surg. 1979; 137: 13-21
- Comparison of distal and proximal splenorenal shunts: a randomized prospective trial.Ann Surg. 1981; 194: 531-544
- The Emory prospective randomized trial: selective versus nonselective shunt to control variceal bleeding. Ten-year follow-up.Ann Surg. 1985; 201: 712-722
- Further report of a prospective randomized trial comparing distal splenorenal shunt with end-to-side portacaval shunt.Gastroenterology. 1985; 88: 424-429
- A randomized trial for the study of the elective surgical treatment of portal hypertension in mansonic schistosomiasis.Ann Surg. 1986; 204: 148-153
- Results of a randomized trial of end-to-side portacaval shunt and distal splenorenal shunt in alcoholic liver disease and variceal bleeding.Gastroenterology. 1986; 91: 802-809
- Distal splenorenal vs. portal-systemic shunts after hemorrhage from varices: a randomized controlled trial.Hepatology. 1988; 8: 1475-1481
- Selective distal splenorenal shunt versus side-to-side portacaval shunt: clinical results of a prospective, controlled study.Am J Surg. 1988; 155: 564-571
- Emergency and definitive treatment of bleeding esophageal varices.JAMA. 1956; 160: 1017-1023
- Selective trans-splenic decompression of gastro-esophageal varices by distal splenorenal shunt.Ann Surg. 1967; 166: 437-455
- Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. Analysis and examples.Br J Cancer. 1977; 35: 1-33
- Bleeding esophageal varices.Surg Clin North Am. 1987; 67: 475-488
- Endoscopic variceal sclerosis compared with distal splenorenal shunt to prevent recurrent variceal bleeding in cirrhosis: a prospective randomized trial.Ann Intern Med. 1990; 112: 262-269
- Shunt surgery versus endoscopic sclerotherapy for variceal hemorrhage: late results of a randomized trial.Am J Surg. 1993; 165: 27-33
- Using transjugular intrahepatic portosystemic shunts to control variceal bleeding before liver transplantation.Ann Intern Med. 1992; 116: 304-309
- Selectivity of the distal splenorenal shunt.Surgery. 1979; 86: 663-671
- Hemodynamic differences between alcoholic and nonalcoholic cirrhotics following distal splenorenal shunt: effect on survival?.Ann Surg. 1983; 198: 325-334
- Distal splenorenal shunt with splenopancreatic disconnection: a four year assessment.Ann Surg. 1989; 210: 332-341
- Critical comparative analysis of early and late results of splenorenal and direct portacaval shunts performed on 169 patients with portal cirrhosis.Ann Surg. 1961; 154: 446-459
- A systemic appraisal of portacaval H-graft diameters: clinical and hemodynamic perspectives.Ann Surg. 1986; 204: 356-364
- Influence of portal hemodynamics on long-term survival of alcoholic cirrhosis patients after small-diameter portacaval H graft.Am J Surg. 1988; 155: 152-158
- Surgical procedures for bleeding esophagogastric varices when sclerotherapy fails: a prospective study.Am J Surg. 1990; 160: 43-47
- Options for elective treatment of portal hypertension in cirrhotic patients in the transplantation era.Am J Surg. 1990; 160: 105-110
- Does the Warren shunt correct hypersplenism?.Hepatobil Surg. 1990; 2: 41-49
☆Presented at the Fiftieth Annual Meeting of the Central Surgical Association, Cincinnati, Ohio, March 4–6, 1993.
© 1993 Published by Elsevier Inc.