INTERDISCIPLINARY MANAGEMENT OF PORTAL-HY PERTENSION - THE IMPORTANCEOF PORTOSYSTEMIC SHUNT OPERATIONS

Decompressive portosystemic shunt operations continue to be part of th e therapeutic concept for hemorrhaging of esophageal varices inspite o f endoscopic sclerotherapy and TIPS. Discussion of the different surgi cal indications, in particular for the emergency shunt. Analysis of ou r own patients. From 1970-1992 we saw 928 patients with bleeding varic es. 755 operations were performed due to variceal bleeding, of these 6 86 portosystemic shunts and 69 disconnection on operations. In 546 (79 .5 %) patients a portocaval anastomosis was performed, of which 356 (6 5.2%) being emergency or early operations and 190 (34.8 %) elective op erations. The mortality, dependent on the degree of hemorrhaging and t he number of previous recurrent bleedings, could be drastically reduce d inspite of a broad indication: to 33 % in emergency shunts, to 6 % i n elective shunts, to 0 % in stage Child A since 1980. In stage Child C, the Warren shunt is preferred. The rate of encephalopathy: 12 % lat ent and reversible, 12 % chronic (alcoholics). Late mortality is depen dent on the status of liver cirrhosis and on alcohol abstinence. The 5 - and 10-year expected survival rates are 72 % or 39 % in abstinent pa tients, and in non-abstinent patients 36 % or 0 %, respectively.