TRANSMESENTERIC-TRANSFEMORAL METHOD OF INTRAHEPATIC PORTOSYSTEMIC SHUNT PLACEMENT WITH MINILAPAROTOMY

PURPOSE: To determine whether the transmesenteric-transfemoral method for intrahepatic portosystemic shunt (IFS) placement is safer and more efficient than the transjugular method. PATIENTS AND METHODS: Sixty-s ix consecutive patients with cirrhosis and bleeding varices underwent 67 IFS procedures. Sixty-one of these procedures were performed using a combination of transfemoral access to the hepatic vein with transmes enteric access to the portal system provided by means of minilaparotom y. Follow-up data were collected periodically by means of clinical eva luation and duplex sonography of the shunt. Angiographic evaluation wa s performed when necessary. RESULTS: No technical failures or periproc edural deaths occurred. The radiologic and surgical portions of the pr ocedure were accomplished within 45 and 55 minutes, respectively. In c ases without portal thrombosis, maximum fluoroscopy time was 12 minute s. During follow-up (mean, 16 months), eight shunt revisions including one additional shunt placement were necessary. CONCLUSION: Transmesen teric-transfemoral IFS placement requires surgical participation but m ay offer improved efficiency and safety compared with regular transjug ular IFS placement.