Latero-lateral portocaval anastomosis in the surgical treatment of portal hypertension: evaluation of a mean follow up of 14 years
Leggeri, A.; Roseano, M.; Gobessi, V.; Eramo, R.
Annali Italiani di Chirurgia 67(1) 49-58; Discussion: 58-59
1996
ISSN/ISBN: 0003-469X PMID: 8712617 Document Number: 462181
After the enthusiasm given by the new treatment techniques of complicated portal hypertension (sclerotherapy, TIPS and liver transplantation), various authors in the literature are considering the role of derivative surgery in the treatment of this affection, due to their consolidated experiences and with a long term follow-up. The authors analyse their own long experience, regarding 104 side-to-side porto-caval shunt. It has been done a complete follow-up, of 71 patients, for a period lasting from 4 to 20 years from the operation. Intraoperative mortality was 5,7%, global morbidity was 28%. Haemorrhagic recurrence from rupture of oesophageal varices was found in 2 cases (1 soon after and the other 3 months from the operation). 5 years survival was depending from Child score (96% Child A, 66,4 Child B, 25% Child C) and from the ethology of cirrhosis (70% for alcoholic cirrhosis and 80% for post-hepatitis cirrhosis). The survival was anyhow mainly connected with the persistence of alcohol abuse. The EPS appeared or became worse after the operation in 12 patients out of 71 checked (16.7%). It has never made a patient enable to lead an ordinary life. Due to the results of their own experience, the authors underline the efficacy of side-to-side porto-caval shunt in the prevention of the haemorrhagic recurrence from oesophageal rupture. In selected patients, Child A and B, not responding to the endoscopic treatment and in elective operations, the mortality was very well contained with a good prevention even after many years and a very small occurrence of EPS. For all those reasons, the side-to-side porto-caval shunt still keeps its validity also towards the selective shunts that are much more difficult technically and that can't be done on ascitic patients.