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Portal Decompressive Surgery: Comparative Evaluation of Patients With Laennec's Cirrhosis and Other Causes

Portal Decompressive Surgery: Comparative Evaluation of Patients With Laennec's Cirrhosis and... Abstract THE PORTAL-systemic shunt represents the definitive treatment for bleeding esophagogastric varices secondary to portal hypertension. The effectiveness of this procedure as a method of obviating future bleeding episodes is generally accepted. However, several questions remain unresolved. The ultimate effect of correcting the portal hypertension on life expectancy of cirrhotic patients has not been satisfactorily determined in controlled series.1,2 Similarly, there have been no well-controlled studies for emergency shunts.3 It is felt that part of the disparity in statistics is related to differences in the patient population of reported results. Therefore, the results of elective and emergency portal-systemic decompressive procedures for bleeding varices in patients with Laennec's cirrhosis and in patients in whom other disorders caused the portal hypertension have been compared. Materials and Methods The present study evaluates the cases of 57 patients who underwent 61 major portal-systemic decompressive procedures at Strong Memorial Hospital between January 1953 and References 1. Garceau, A.J., et al: A Controlled Trial of Prophylactic Portacaval-Shunt Surgery , New Eng J Med 270:496, 1964.Crossref 2. Jackson, F.C., et al: Clinical Investigation of the Portacaval Shunt , Arch Surg 91:43-54 ( (July) ) 1965.Crossref 3. Grace, N.D.; Muench, H.; and Chalmers, T.C.: The Present Status of Shunts for Portal Hypertension in Cirrhosis , Gastroenterology 50:684, 1966. 4. Schwartz, S.I., et al: The Use of Intravenous Pituitrin in Treatment of Bleeding Esophageal Varices , Surgery 45:72, 1958. 5. Child, C.G., III: The Liver and Portal Hypertension , Philadelphia: W. B. Saunders Co., 1964, p 50. 6. Summerskill, W.H.J., et al: Cirrhosis of the Liver: A Study of Alcoholic and Nonalcoholic Patients in Boston and London , New Eng J Med 262:1, 1960.Crossref 7. Foster, J.H., and Vetto, R.M.: Fifteen Years' Experience With Portosystemic Venous Shunting Operations , Amer Surg 33:514, 1967. 8. Gordon, H.E., and Glantz, G.: Elective Treatment of Bleeding Esophageal Varices , Curr Probl Surg pp 4-13, (July) , 1966. 9. Schriefers, K-H.: Indications and Operative Results in 200 Portacaval Shunt-Operations , J Cardiov Surg 7:485, 1965. 10. Koenemann, L.C., and Ceballos, R.: Massive Hepatic Necrosis Following Portacaval Shunt , JAMA 198:138-42 ( (Oct 10) ) 1966.Crossref 11. Orloff, M.J.: Emergency Treatment of Bleeding Esophageal Varices in Cirrhosis , Curr Probl Surg pp 13-28, (July) , 1966. 12. Ekman, C.A., and Sandblom, P.: Shunt Operation in Acute Bleeding From Esophageal Varices , Ann Surg 160:531, 1964.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Portal Decompressive Surgery: Comparative Evaluation of Patients With Laennec's Cirrhosis and Other Causes

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Publisher
American Medical Association
Copyright
Copyright © 1968 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1968.01340030031001
Publisher site
See Article on Publisher Site

Abstract

Abstract THE PORTAL-systemic shunt represents the definitive treatment for bleeding esophagogastric varices secondary to portal hypertension. The effectiveness of this procedure as a method of obviating future bleeding episodes is generally accepted. However, several questions remain unresolved. The ultimate effect of correcting the portal hypertension on life expectancy of cirrhotic patients has not been satisfactorily determined in controlled series.1,2 Similarly, there have been no well-controlled studies for emergency shunts.3 It is felt that part of the disparity in statistics is related to differences in the patient population of reported results. Therefore, the results of elective and emergency portal-systemic decompressive procedures for bleeding varices in patients with Laennec's cirrhosis and in patients in whom other disorders caused the portal hypertension have been compared. Materials and Methods The present study evaluates the cases of 57 patients who underwent 61 major portal-systemic decompressive procedures at Strong Memorial Hospital between January 1953 and References 1. Garceau, A.J., et al: A Controlled Trial of Prophylactic Portacaval-Shunt Surgery , New Eng J Med 270:496, 1964.Crossref 2. Jackson, F.C., et al: Clinical Investigation of the Portacaval Shunt , Arch Surg 91:43-54 ( (July) ) 1965.Crossref 3. Grace, N.D.; Muench, H.; and Chalmers, T.C.: The Present Status of Shunts for Portal Hypertension in Cirrhosis , Gastroenterology 50:684, 1966. 4. Schwartz, S.I., et al: The Use of Intravenous Pituitrin in Treatment of Bleeding Esophageal Varices , Surgery 45:72, 1958. 5. Child, C.G., III: The Liver and Portal Hypertension , Philadelphia: W. B. Saunders Co., 1964, p 50. 6. Summerskill, W.H.J., et al: Cirrhosis of the Liver: A Study of Alcoholic and Nonalcoholic Patients in Boston and London , New Eng J Med 262:1, 1960.Crossref 7. Foster, J.H., and Vetto, R.M.: Fifteen Years' Experience With Portosystemic Venous Shunting Operations , Amer Surg 33:514, 1967. 8. Gordon, H.E., and Glantz, G.: Elective Treatment of Bleeding Esophageal Varices , Curr Probl Surg pp 4-13, (July) , 1966. 9. Schriefers, K-H.: Indications and Operative Results in 200 Portacaval Shunt-Operations , J Cardiov Surg 7:485, 1965. 10. Koenemann, L.C., and Ceballos, R.: Massive Hepatic Necrosis Following Portacaval Shunt , JAMA 198:138-42 ( (Oct 10) ) 1966.Crossref 11. Orloff, M.J.: Emergency Treatment of Bleeding Esophageal Varices in Cirrhosis , Curr Probl Surg pp 13-28, (July) , 1966. 12. Ekman, C.A., and Sandblom, P.: Shunt Operation in Acute Bleeding From Esophageal Varices , Ann Surg 160:531, 1964.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Sep 1, 1968

References