Distal splenorenal vs. portal-systemic shunts after hemorrhage from varices: A randomized controlled trial

✍ Scribed by Norman D. Grace; Harold O. Conn; Robert H. Resnick; Roberto J. Groszmann; Colin E. Atterbury; Stephen C. Wright; Richard J. Gusberg; Rudolph Vollman; Guadalupe Garcia-Tsao; Rosemarie L. Fisher; Edward T. O'Hara; William V. McDermott; J. Peter Maselli; Warren Widrich; Daniel S. Matloff; Douglas Horst; Naomi Banks; Jeanne Alberts

• Publisher: John Wiley and Sons
• Year: 1988
• Tongue: English
• Weight: 812 KB
• Volume: 8
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.1840080602

✦ Synopsis

Between 1975 and 1983, 303

cirrhotic patients with endoscopically proven major variceal hemorrhage were admitted to the participating hospitals of the Boston-New Haven Collaborative Liver Group. Of these, 274 were evaluated for admission to a prospective, randomized controlled trial comparing portal-systemic shunts with distal splenorenal shunts. The criteria for inclusion were as follows: (i) a portohepatic pressure gradient 212 mmHg; (ii) angiographic evidence of antegrade portal venous flow; (iii) angiographic demonstration that the inferior vena cava and portal, splenic and left renal veins were anatomically suitable for either a portalsystemic or distal splenorenal shunt, and (iv) the patient was a reasonable operative risk. Eighty-one patients from the six participating hospitals fulfilled the criteria and consented to participate. Thirty-eight patients were randomly assigned to have portal-systemic shunt and 4 3 to have distal splenorenal shunt.

After a follow-up period of 11 years (mean = 3.5 years for all patients), survival was found to be similar in the two groups of patients. The 30-day operative mortality was 13% for the portal-systemic shunt group and 9% for the distal splenorenal shunt patients. Late mortality was 55% for the portal-systemic shunt and 37% for the distal splenorenal shunt group. Total mortality was 68% for the portal-systemic shunt and 46% for the distal sple-