Which is the best surgery for budd-chiari syndrome: Venous decompression or liver transplantation? a single-center experience with 50 patients
✍ Scribed by Burckhardt Ringe; Hauke Lang; Karl-Jürgen Oldhafer; Michael Gebel; Peer Flemming; Axel Georgii; Hans-Georg Borst; Rudolf Pichlmayr
- Publisher
- John Wiley and Sons
- Year
- 1995
- Tongue
- English
- Weight
- 836 KB
- Volume
- 21
- Category
- Article
- ISSN
- 0270-9139
No coin nor oath required. For personal study only.
✦ Synopsis
The optimal treatment of Budd-Chiari syndrome (BCS) remains an open question. It is still a matter of controversial discussion whether venous decompression or liver transplantation is superior. To elucidate the role and prognosis of both surgical options in our own experience, a consecutive series of 50 patients treated between 1981 and 1993 was retrospectively analyzed. Twelve patients had different types of portosystemic shunts or local decompressive procedures, and transplantation was performed in 43 cases, including five with previous conventional surgery. The overall mortality of 18 of 50 was concentrated within the early postoperative period, with no patient lost after 1 year. In the venous decompression group, the success rate was only 2996, and treatment failure was closely related to the finding of cirrhosis or technical problems like vascular thrombosis. After transplantation, early complications were rejection, primary nonfunction, or graft necrosis, and contributed significantly to the risk of sepsis. Thirty of 43 liver recipients are currently alive, including four rescued after failed decompressive surgery, with 1-and 10-year survival of 69%, and excellent recurrence-free rehabilitation. These results clearly indicate that patient selection plays a dominant prognostic role in the treatment of BCS. Venous decompression and liver transplantation should both be integrated in a common therapeutic concept, and the individual decision for the preferred approach must be based on the leading clinical symptom: portal hypertension or liver failure, together with the assessment of reversibility of hepatic damage, and the potential of cure of the underlying disease. (HEPATOLOGY 1995;21:1337-1344.)
Since the first mention of hepatic vein occlusion in medical literature, the syndrome created later has lost nothing of its mystery and fascination until now. The reason is a high degree of variability, with regard to Ahhrcviation: BCS, Budd-Chiari syndrome. From the 'Klinik fur Abdominal-und Transplantationschimrgie, 'Abteilung Gastrtwnterologic und Hepatologie, 'Pdthologisches Institut, 'Klinik f%r Thorax-,