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Experience With Interposition Mesocaval Shunt for Management of Variceal Bleeding

Experience With Interposition Mesocaval Shunt for Management of Variceal Bleeding Abstract • We present an experience with 20 patients undergoing interposition mesocaval shunts for decompression of esophageal varices. There were 14 men and six women, ranging in age from 32 to 80 years. Two patients were classified as good risks, nine as moderate risks, and nine as poor risks. There were ten elective operations, seven urgent operations, and three emergency procedures. An operative mortality of 10% was noted in the entire group, with one late death due to shunt occlusion. All deaths occurred in the emergency group. A shunt patency of 88% and minimal problems with postoperative hepatic encephalopathy were noted. The interposition mesocaval shunt is judged to be a safe, technically easy procedure that is currently a satisfactory solution to the problem of hemorrhage from esophageal varices. (Arch Surg 112:593-595, 1977) References 1. Thompson B, Read RC: Proceedings: Interposition "H" grafting for portal hypertension . Arch Surg 108:502-506, 1974.Crossref 2. Drapanas T: Interposition mesocaval shunt for treatment of portal hypertension . Ann Surg 176:435-448, 1972.Crossref 3. Giles GR, Brennan TG, Losanski MS: Interposition Teflon mesenteric caval shunt for bleeding esophageal varices . Br J Surg 60:649-652, 1973.Crossref 4. Drapanas T, Lacecero J, Dowling JB: Hemodynamics of the interposition mesocaval shunt . Ann Surg 181:523-533, 1975.Crossref 5. Malt RA: Emergency and elective operation for bleeding esophageal varices . Surg Clin North Am 54:561-571, 1974. 6. Hermann RE: Shunt operations for portal hypertension . Surg Clin North Am 55:1073-1087, 1975. 7. Gliedmann ML, Margulies M: The side-to-end superior mesenteric vein-inferior cava shunt for portal hypertension . Surgery 56:473, 1964. 8. Turcotte JG, Wallin WV, Child CG III: End-to-side vs side-to-side portocaval shunts in patients with hepatic cirrhosis . Am J Surg 117:108-116, 1969.Crossref 9. Reynolds JT, Southwick HW: Portal hypertension: Use of venous grafts when side-to-side anastomosis is impossible . Arch Surg 62:789, 1951.Crossref 10. Theron P: Portacaval shunt operations with special reference to the use of vein grafts . S Afr Med J 27:73, 1953. 11. Stipa S, Thau A, Cavallaro A, et al: A technique for mesentericocaval shunt . Surg Gynecol Obstet 137:285-287, 1973. 12. Thompson BW, Read RC: Use of autogenous jugular vein for interposition grafting in portal hypertension . South Med J 66:818-822, 1973.Crossref 13. Lord JW, Rossi G, Daliana M, et al: Portosplenic shunts in the management of massive hemorrhage from esophageal varices due to cirrhosis of the liver . Am J Surg 121:241-248, 1971.Crossref 14. Peracchia A: Interposition mesocaval shunt for intractable cirrhotic ascites . Ateneo Parmese [Acta Biomed] 46:101-111, 1975. 15. Holyoke EA, Davis WC, Harry RD: Surgical anatomy of the mesocaval shunt . Surgery 78:526-530, 1975. 16. Inokuchi K, Kabayashi MD, Ogaya Y, et al: Results of left gastric vena caval shunt for esophageal varices: Analysis of 100 clinical cases . Surgery 78:628-636, 1975. 17. Warren WD, Salam AA, Smith RB: Selective distal splenorenal shunt: Technique and results of operation . Arch Surg 108:306-314, 1974.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Experience With Interposition Mesocaval Shunt for Management of Variceal Bleeding

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Publisher
American Medical Association
Copyright
Copyright © 1977 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1977.01370050053008
Publisher site
See Article on Publisher Site

Abstract

Abstract • We present an experience with 20 patients undergoing interposition mesocaval shunts for decompression of esophageal varices. There were 14 men and six women, ranging in age from 32 to 80 years. Two patients were classified as good risks, nine as moderate risks, and nine as poor risks. There were ten elective operations, seven urgent operations, and three emergency procedures. An operative mortality of 10% was noted in the entire group, with one late death due to shunt occlusion. All deaths occurred in the emergency group. A shunt patency of 88% and minimal problems with postoperative hepatic encephalopathy were noted. The interposition mesocaval shunt is judged to be a safe, technically easy procedure that is currently a satisfactory solution to the problem of hemorrhage from esophageal varices. (Arch Surg 112:593-595, 1977) References 1. Thompson B, Read RC: Proceedings: Interposition "H" grafting for portal hypertension . Arch Surg 108:502-506, 1974.Crossref 2. Drapanas T: Interposition mesocaval shunt for treatment of portal hypertension . Ann Surg 176:435-448, 1972.Crossref 3. Giles GR, Brennan TG, Losanski MS: Interposition Teflon mesenteric caval shunt for bleeding esophageal varices . Br J Surg 60:649-652, 1973.Crossref 4. Drapanas T, Lacecero J, Dowling JB: Hemodynamics of the interposition mesocaval shunt . Ann Surg 181:523-533, 1975.Crossref 5. Malt RA: Emergency and elective operation for bleeding esophageal varices . Surg Clin North Am 54:561-571, 1974. 6. Hermann RE: Shunt operations for portal hypertension . Surg Clin North Am 55:1073-1087, 1975. 7. Gliedmann ML, Margulies M: The side-to-end superior mesenteric vein-inferior cava shunt for portal hypertension . Surgery 56:473, 1964. 8. Turcotte JG, Wallin WV, Child CG III: End-to-side vs side-to-side portocaval shunts in patients with hepatic cirrhosis . Am J Surg 117:108-116, 1969.Crossref 9. Reynolds JT, Southwick HW: Portal hypertension: Use of venous grafts when side-to-side anastomosis is impossible . Arch Surg 62:789, 1951.Crossref 10. Theron P: Portacaval shunt operations with special reference to the use of vein grafts . S Afr Med J 27:73, 1953. 11. Stipa S, Thau A, Cavallaro A, et al: A technique for mesentericocaval shunt . Surg Gynecol Obstet 137:285-287, 1973. 12. Thompson BW, Read RC: Use of autogenous jugular vein for interposition grafting in portal hypertension . South Med J 66:818-822, 1973.Crossref 13. Lord JW, Rossi G, Daliana M, et al: Portosplenic shunts in the management of massive hemorrhage from esophageal varices due to cirrhosis of the liver . Am J Surg 121:241-248, 1971.Crossref 14. Peracchia A: Interposition mesocaval shunt for intractable cirrhotic ascites . Ateneo Parmese [Acta Biomed] 46:101-111, 1975. 15. Holyoke EA, Davis WC, Harry RD: Surgical anatomy of the mesocaval shunt . Surgery 78:526-530, 1975. 16. Inokuchi K, Kabayashi MD, Ogaya Y, et al: Results of left gastric vena caval shunt for esophageal varices: Analysis of 100 clinical cases . Surgery 78:628-636, 1975. 17. Warren WD, Salam AA, Smith RB: Selective distal splenorenal shunt: Technique and results of operation . Arch Surg 108:306-314, 1974.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: May 1, 1977

References