MESOCAVAL INTERPOSITION SHUNTING IN THE TREATMENT OF BLEEDING ESOPHAGEAL-VARICES

Objective: To assess the longterm results of mesocaval interposition s hunt in the treatment of bleeding oesophageal varices. Design: Retrosp ective study. Setting: University hospital, Sweden. Subjects: 60 patie nts with bleeding oesophageal varices in all Child's classes. 20 of wh om were operated on as emergencies, and 40 as elective cases. Interven tions: A 14 mm polytetrafluoroethylene graft was used as an interposit ion shunt between the superior mesenteric vein and the vena cava. Main outcome measures: Rebleeding rate, portal blood flow, hepatic encepha lopathy, morbidity, mortality, and survival. Results: Rebleeding was r are and occurred mainly during the first 4 months after operation, (n = 5) in 10% of the patients, and at the 24 month follow-up, (n = 4) in 11% of the patients. Portal flow was measured preoperatively in 33 pa tients and in 22 (67%) it was hepatopetal. During follow-up it was rev ersed and after 24 months no patient had hepatopetal flow. Hepatic enc ephalopathy was present in 18 patients (20%) during follow-up. Shunts thrombosed in 9 patients (15%), 8 of which required reoperation. There was no operative mortality, but 4 patients (7%) died within 30 days o f surgery. The main late cause of death (18/26) was liver failure. The 1 year survival was 80%, the 3 year survival 70% and the 5 year survi val 60%. Conclusions: The mesocaval interposition shunt gives good lon gterm results and can be recommended both as an emergency and an elect ive procedure for patients with portal hypertension and bleeding oesop hageal varices that are unresponsive to sclerotherapy.