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.
|Number of pages||8|
|Publication status||Published - 2000|
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