[Mesocaval anastomosis in the treatment of recurring hemorrhage caused by portal hypertension]

Service de Chirurgie Viscérale, CHU Angers.

The ideal therapy for variceal hemorrhage would permanently eliminate this life-threatening complication of portal hypertension and have no adverse effects on hepatic physiology. Mesocaval interposition shunts preserve a hepato-pedal blood flow. 35 shunts were performed as an elective procedure from 1982 to 1992 in patients with hemorrhagic liver cirrhosis. There were 24 men and 11 women, with a median age of 51.7 years. The underlying etiology of the varices was alcoholic cirrhosis in 31 patients. The criteria of Child-Pugh were utilised to evaluate + all patients; 21 were in class A and 14 were in class B. All patients presented before the operation, two or several histories of acute variceal hemorrhage. The mean diameter of the graft was 14 mm (range 10 to 16 mm). Intra-operative portal pressure measurements showed satisfactory pressure reduction (18.7 mmHg to 11.2 mmHg). There was no death in the postoperative period. Eight patients had postoperative complications, for an overall morbidity rate of 22.8%: 2 ascites, 4 episodes of temporary encephalopathies and 2 recurrent bleeding. At the third month, angiographic (5 cases), sonographic (6 cases) or scanographic (17 cases) studies evaluated shunt patency. In one case, We observed an occluded graft. The actuarial survival rate was 82% at 2 years, 66% at 5 years. It is concluded that the interposition mesocaval shunt appears to be an effective technique for the control of variceal hemorrhage, has important hemodynamic advantages and can be applied to most patients for the control of variceal hemorrhage due to portal hypertension. Moreover, the procedure can be considered as a solution before the hepatic transplantation.

PMID: 8163615 [PubMed - indexed for MEDLINE]