IMPROVEMENT IN ESOPHAGEAL-VARICES AND LIVER HISTOLOGY POSTOPERATIVELYIN BUDD-CHIARI-SYNDROME

Background. In the past 17 years, 32 patients with Budd-Chiari syndrom e were treated by reconstruction of the occluded inferior vena cava an d reopening of the hepatic veins under femoro-femoral normothermic ext racorporeal partial bypass. The mean follow-up was 8 years (range, 1.5 to 17 years). Methods. To evaluate the benefits of our operative proc edure, we compared the preoperative, early postoperative, and late pos toperative endoscopic appearance of the esophageal varices and the his tologic findings of the liver tissue obtained intraoperatively and at a later date. Results. The esophageal varices found preoperatively in 29 patients (90.6%) had disappeared in 7 patients by the time of disch arge, and in 2 patients they disappeared 4 to 7 years after surgery. I n the remaining 20 patients, the grade of the esophageal varices was r educed markedly. Histologic examination of the liver showed cirrhosis in 22 patients, fibrosis in 9 patients, and severe congestion in 1 pat ient. Inspection of the liver in the late postoperative period (in 10 patients) showed improvement in centrilobular congestion and no increa se in interlobular fibrosis. Conclusions. Gradual and steady improveme nt of esophageal varices and hepatic fibrosis can be achieved after ou r operative procedure. (C) 1998 by The Society of Thoracic Surgeons.