PMID: 6974543Oct 1, 1981Paper

Comparison of distal and proximal splenorenal shunts: a randomized prospective trial

Annals of Surgery
J E FischerR Welling

Abstract

Controversy still surrounds the place of portalsystemic shunting in the therapy of bleeding esophageal varices. Recently, a selective shunt, the distal splenorenal shunt, has achieved some degree of popularity and, apparently, is associated with less chronic encephalopathy. Because of this, a trial was initiated at the Massachusetts General Hospital and continued at the University of Cincinnati Medical Center, prospectively randomizing central and distal splenorenal shunts in consecutive elective cases of patients with established variceal bleeding. Preoperative evaluation included endoscopic examination at the time of hemorrhage, angiography and upper gastrointestinal series, emphasis on mental function including EEG, amino acids, neurologic examination, as well as standard liver chemistries. Nineteen patients underwent central splenorenal shunts and 23 distal splenorenal shunt. There was one operative death from hemorrhagic pancreatitis in a Child's Class A patient with distal splenorenal shunt. Four late deaths, from gunshot wound, auto accident, overwhelming pneumonitis similar to postsplenectomy syndrome, and metastatic carcinoma (2.5 years after operation), have been recorded in the distal splenorenal shunt group, and non...Continue Reading

References

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Citations

Mar 1, 1994·World Journal of Surgery·S StipaG Lucandri
Oct 1, 1984·World Journal of Surgery·J M HendersonW D Warren
Mar 1, 1985·The Japanese Journal of Surgery·J Terblanche
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