Is There Still a Role for Surgical Shunts in the Treatment of Budd-Chiari Syndrome? A 25-Year Experience

Abstract

Purpose

To investigate the long-term results of shunt surgery in the treatment of Budd-Chiari Syndrome.

Methods

Medical records of patients treated with Budd-Chiari Syndrome between 1993 and 2006 were reviewed.

Results

Thirty-seven patients (26 female, 11 male) were identified, with a median age of 30 years (range 14–51). Median duration of symptoms was 3 months (range 1 month to 10 years). Twenty-five patients, all in acute or subacute stages of disease, were treated surgically. Constructed shunts were mesoatrial in 17, portocaval in five (one was converted from a failed portorenal shunt) and mesocaval in three. Median portal pressure decreased from 44 cm H2O (range 31–55) to 20 cm H2O (range 5–27). Seven patients (28%) died in the perioperative period. Eighteen patients (72%) were followed up for a median of 186 months (24–241 months). Seven patients died during follow-up, five due to reasons related to the underlying cause and treatment. Remaining 11 patients (61%) were alive at a median of 18 years (13–25 years) with patent shunts. One-, 5-, and 10-year survival rates in patients undergoing shunt surgery were 78%, 72%, and 66%, respectively.

Conclusion

Portosystemic shunts may still be considered when expertise for transjugular intrahepatic portosystemic shunt or liver transplantation is not available.

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Authors

Contributions

KRS, YT and AE equally worked for the design, acquisition and analysis of the data and revised the study critically. KRS drafted the work.

Corresponding author

Correspondence to Kursat Rahmi Serin.

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None of the authors have any financial relationship with any organization or sponsorship for this research. All authors state that they have full control of all primary data and they agree to allow the journal to review their data if requested.

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Serin, K.R., Tekant, Y. & Emre, A. Is There Still a Role for Surgical Shunts in the Treatment of Budd-Chiari Syndrome? A 25-Year Experience. J Gastrointest Surg 24, 1359–1365 (2020). https://doi.org/10.1007/s11605-020-04524-7

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Keywords

  • Liver surgery
  • Portal hypertension
  • Surgical shunt