Liver function and encephalopathy after partial vs direct side-to-side portacaval shunt: A prospective randomized clinical trial

Lorenzo Capussotti, Vincenzo Vergara, Roberto Polastri, Hedayat Bouzari, Giovanni Galatola

Research output: Contribution to journalArticle

Abstract

Background. The aim of this study was to determine, in a prospective randomized clinical trial, whether the partial portacaval shunt offers any advantage in terms of liver function and encephalopathy rate when compared with direct side-to-side direct portacaval shunt. Methods. Forty-six 'good risk' patients with cirrhosis and with documented variceal hemorrhage were randomly assigned to either a partial shunt procedure (achieved by 10-mm diameter interposition portacaval H-graft) or direct small-diameter side-to- side portacaval anastomosis. Results. Operative mortality was zero in both groups. During the follow-up period, encephalopathy developed in 3 patients in the partial shunt group and 9 in the direct shunt group (P = .04). Kaplan- Meier analysis demonstrated that encephalopathy-free survival was significantly longer in the partial shunt group (P = .025). Direct shunt patients had significant hepatic functional deterioration postoperatively compared with the partial shunt group. Conclusions. The partial portacaval shunt effectively controls variceal hemorrhage. Compared with direct side-to- side portacaval shunt, partial shunt preserves long-term hepatic function and minimizes postoperative encephalopathy. We conclude that the partial portacaval shunt is the preferred approach over direct shunts for patients with cirrhosis and with variceal bleeding.

Original languageEnglish
Pages (from-to)614-621
Number of pages8
JournalSurgery
Volume127
Issue number6
Publication statusPublished - 2000

ASJC Scopus subject areas

  • Surgery

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    Capussotti, L., Vergara, V., Polastri, R., Bouzari, H., & Galatola, G. (2000). Liver function and encephalopathy after partial vs direct side-to-side portacaval shunt: A prospective randomized clinical trial. Surgery, 127(6), 614-621.