Transjugular intrahepatic portosystemic shunt versus distal splenorenal shunt - A comparative study

Background/Aims: No general consensus exists regarding the proper surgical management of recurrent variceal bleeding due to hepatic cirrhosis. Transju gular intrahepatic portosystemic shunt and distal splenorenal shunt are inc reasingly being performed in the management of these patients. The present study was undertaken to compare the efficacy, complications and survival ra te of these two procedures. Methodology: Sixty-seven patients with alcoholic liver cirrhosis of Child-P ugh's class A (n=22) and class B (n=45) with recurrent variceal bleeding no t controlled by conservative means underwent either transjugular intrahepat ic portosystemic shunt placement (n=35) or a distal splenorenal shunt opera tion (n=32). These patients were followed for a mean of 887+/-189 days. Bot h groups were compared with respect to the rates of survival, recurrence of gastrointestinal bleeding, encephalopathy, ascitis, shunt blockade and oth er relevant biochemical parameters. Results: Patients who underwent a distal splenorenal shunt operation had lo wer rates of recurrence of gastrointestinal bleeding (6.25% vs. 25.71%), en cephalopathy (18.75% vs. 42.86%) shunt blockade (6.25% vs. 68.57%) and lowe r mean fasting blood ammonia levels (56.70+/-7.10 mu mol/L vs. 61.70+/-5.70 mu mol/L). However the rate of ascitis was higher amongst these patients ( 40.63% vs. 11.43%). There was no significant difference in the midterm surv ival rates between these groups (81.25% vs. 80.00%). Both procedures were e ffective in controlling functional renal failure, splenomegaly and features of hypersplenism. Conclusions: Distal splenorenal shunt operation is a better therapeutic opt ion than transjugular intrahepatic portosystemic shunt placement for contro l of recurrent variceal bleeding due to hepatic cirrhosis.