EVALUATION AND LONG-TERM RESULTS OF MESOC AVAL INTERPOSITION SHUNTS

The ideal therapy for variceal hemorrhage would permanently eliminate this life-threatening complication of portal hypertension and have no adverse effects on hepatic physiology. Mesocaval interposition shunts preserve a hepatopedal blood flow. 35 shunts were performed as an elec tive procedure from 1982 to 1992 in patients with hemorragic liver cir rhosis. There were 24 men and II women, with a median age of 51.7 year s. The underlying etiology of the varice was alcoholic cirrhosis in 31 patients. The criteria of Child-Pugh were utilised to evaluate all pa tients; 21 were in class A and 14 were in class B. All patients presen ted before the operation, two or several histories of acute variceal h emorrhage. The mean diameter of the graft was 14 mm (range Ia to 16 mm ). Intra-operative portal pressure measurements showed satisfactory pr essure reduction (18.7 mmHg to 11.2 mmHg). There was no death in the p ostoperative period. Eight patients had postoperative complications, f or an overall morbidity rate of 22.8 %: 2 ascites, 4 episods of tempor ary encephalopathies and 2 recurrent bleeding. At the third month, ang iographic (5 cases), sonographic (6 cases) or scanographic (17 cases) studies evaluated shunt patency. In one case, We observed an occluded graft. The actuarial survival rate was 82 % at 2 years, 66 % at 5 year s. It is concluded that the interposition mesocaval shunt appears to b e an effective technique for the control of variceal hemorrhage, has i mportant hemodynamic advantages and can be applied to most patients fo r the control of variceal hemorrhage due to portal hypertension. Moreo ver, the procedure can be considered as a solution before the hepatic transplantation.