DISTAL SPLENORENAL SHUNT FOR NONCIRRHOTIC VARICEAL BLEEDING IN BLACK SOUTH-AFRICANS

Distal splenorenal shunt (DSRS) is a once-only form of treatment. It i s suitable for many black South Africans with non-cirrhotic variceal b leeding who cannot attend repeated follow-up sclerotherapy sessions. H owever, persistent hyperbilirubinaemia and encephalopathy may occur fo llowing DSRS in schistosomiasis. Forty-one consecutive patients with D SRS have been treated over a 7-year period. The causes of portal hyper tension were schistosomiasis (32), portal vein thrombosis (8) and diff use nodular hyperplasia (1). Operative mortality was 6%. Encephalopath y was observed in 1 patient. Galactose elimination capacity (GEC) and technetium-diethylenetriamine penta-acetic acid hepatic perfusion inde x (HPI) were used to assess liver function and hepatic perfusion pre- and postoperatively, respectively, in schistosomiasis. GEC was 348 +/- 37 (M +/- SD) before, compared with 343 +/- 67 postoperatively (P = 0 ,78). HPI showed long-term preservation of hepatopetal portal venous f low following DSRS. Morbidity and mortality were observed only in pati ents with schistosomiasis associated with hepatitis B chronic active h epatitis. DSRS is ideal treatment in selected patients with non-cirrho tic variceal bleeding.