MEDIUM APERTURE MESOCAVAL SHUNTS RELIABLY PREVENT RECURRENT VARICEAL HEMORRHAGES

BACKGROUND: Objectives of partial medium aperture mesocaval shunts (MC S) include reduction of portal hypertension to prevent recurrent varic eal hemorrhage, preservation of portal flow through liver while mainta ining an intact porta hepatis to facilitate a future liver transplant (OLTx). PATIENTS AND METHODS: Fifteen patients were retrospectively an alyzed to review the indications for the procedure, its short- and lon g-term complications as well as patency and functional status of the s hunt. They were followed for a period of 21 months. RESULTS: The perio perative and long-term mortality rate was 0%. Rebleeding rate perioper atively and in follow-up was 0%. Early shunt nonfunction was 13% and p ost-shunt encephalopathy (PSE) was 20%. The encephalopathy was grade I to II and controlled medically. Abdominal ultrasound and Doppler conf irmed 13 patent shunts (2 patients did not agree to ultrasound) with p reserved hepatopetal flow in 10. CONCLUSIONS: Medium aperture MCS util izing ringed polytetrafluoroethylene (PTFE) grafts safely and reliably prevent recurrent variceal hemorrhage. Encephalopathy is infrequent a nd mild. This technique preserves the portal venous anatomy making 21 future OLTx technically easier.