Should both schistosomal and nonschistosomal variceal bleeders be disconnected?

Splenopancreatic disconnection (SPD) was conceived and implemented as a technical addition to distal splenorenal shunt (DSRS) to maintain its selectivity and preserve portal perfusion. The proposed hemodynamic and metabolic stability of hepatocytes after DSRS‐SPD should improve survival. In this non...

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Bibliographic Details
Published in:World journal of surgery 1991-05, Vol.15 (3), p.389-397
Main Authors: Abu‐Elmagd, Kareem M., Ezzat, Farouk A., Fathy, Omar M., El‐Ghawlby, Nabih A., Aly, Mohamed A., El‐Fiky, Amgad M., El‐Barbary, Mohsen H., El‐Ebady, Gamal E., El‐Hak, Nabil G.
Format: Article
Language:English
Subjects:
Adult
Esophageal and Gastric Varices - etiology
Esophageal and Gastric Varices - surgery
Female
Gastrointestinal Hemorrhage - etiology
Hepatic Encephalopathy - etiology
Humans
Hypertension, Portal - complications
Liver Cirrhosis - complications
Liver Cirrhosis - metabolism
Liver Cirrhosis - mortality
Liver Diseases, Parasitic - complications
Liver Diseases, Parasitic - metabolism
Liver Diseases, Parasitic - mortality
Male
Mese
Pancreatitis
Portal Perfusion
Postoperative Complications
Recurrence
Schistosomiasis - complications
Schistosomiasis - metabolism
Schistosomiasis - mortality
Shunt Patency
Splenorenal Shunt
Splenorenal Shunt, Surgical - methods
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Summary:Splenopancreatic disconnection (SPD) was conceived and implemented as a technical addition to distal splenorenal shunt (DSRS) to maintain its selectivity and preserve portal perfusion. The proposed hemodynamic and metabolic stability of hepatocytes after DSRS‐SPD should improve survival. In this nonrandomized study, 145 consecutive (Child A/B) variceal bleeders were electively subjected to selective shunt with DSRS in 93 and DSRS‐SPD in 52 patients. The 2 groups were similar before surgery with a mean follow up of 24±12 (DSRS) and 27±14 (DSRS‐SPD) months. DSRS‐SPD had an operative mortality of 3.8%. Postoperative pancreatitis occurred in 7.7% after DSRS‐SPD and 3.2% after DSRS alone, with schistosomal hepatic fibrosis representing 86% of morbid cases. Shunt patency was high and recurrent variceal hemorrhage was low in both groups. Clinical encephalopathy was significantly reduced after DSRS‐SPD (p
ISSN:0364-2313
1432-2323
DOI:10.1007/BF01658738