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Partial Portal Decompression: Initial Clinical Experience with Small-Stoma Portacaval Shunt

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Hepatic Encephalopathy

Part of the book series: Experimental Biology and Medicine ((EBAM,volume 22))

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Abstract

To test the hypothesis that partial portal decompression to treat variceal hemorrhage will diminish subsequent encephalopathy, 50 consecutive patients were studied following small-stoma (10–12 mm) side-to-side portacaval shunt (PCS). During follow-up averaging 26 months, 6 patients (12%) died. Four patients (8%) re-bled, only 1 from varices. All patients (100%) had patent shunts at subsequent angiography and/or ultrasonography. Despite consistent (100%) post-shunt reversal or stagnation of portal flow on duplex scan, encephalopathy on clinical and psychometric grounds was observed in only 3 patients (6%).

This study suggests that small-stoma PCS can be performed with reliably low rates of rebleeding and encephalopathy. That encephalopathy was rare in the absence of hepatic portal perfusion incriminates other factors besides portal flow in the genesis of post-shunt hepatic failure.

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Author information

Authors and Affiliations

  1. From the Department of Surgery, Harborview, Medical Center, School of Medicine, University of Washington, Seattle, Washington, USA

    Kaj Johansen MD, PhD

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  1. Kaj Johansen MD, PhD
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Editor information

Editors and Affiliations

  1. Laboratory of Neurochemistry, André-Viallet Clinical Research Centre, Hôpital St-Luc (University of Montreal), Montreal, Quebec, Canada

    Roger F. Butterworth PhD

  2. Hepatology Unit, André-Viallet Clinical Research Centre, Hôpital St-Luc (University of Montreal), Montreal, Quebec, Canada

    Gilles Pomier Layrargues MD

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© 1989 The Humana Press Inc.

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Johansen, K. (1989). Partial Portal Decompression: Initial Clinical Experience with Small-Stoma Portacaval Shunt. In: Butterworth, R.F., Layrargues, G.P. (eds) Hepatic Encephalopathy. Experimental Biology and Medicine, vol 22. Humana Press. https://doi.org/10.1007/978-1-4612-4506-3_37

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  • DOI: https://doi.org/10.1007/978-1-4612-4506-3_37

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-4612-8851-0

  • Online ISBN: 978-1-4612-4506-3

  • eBook Packages: Springer Book Archive

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