Complications and Patency Rate of Portosystemic Shunts in Chronic Liver Diseases

Document Type : Research Paper

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Abstract

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ntroduction:Cirrhosis is the most important etiology of portal hypertension worldwide. Even with improvements in noninvasive therapies, portosystemic shunts still remain one of the most important approaches after failure in medical treatment. Transjugular Intrahepatic Portosystemic shunt and liver transplantation are alternatively used in other countries. Evaluation of complications and patency rates can be a great help in choosing the best technique in patients. The aim of this study was to evaluate patency rate and complications of portosystemic shunts in patients with chronic hepatic diseases.
Materiasl and Methods: In this cross sectional study, from summer 2000 to spring 2004, carried out at General and Vascular Surgery Departments 19 patients with portal hypertension underwent surgery. Patients with portosystemic shunts were followed up for at least one year after surgery, considering blood flow in anastomosis, using color Doppler ultrasonography and symptoms such as gastro intestinal bleeding, hepatic encephalopathy and etc. Data were analyzed using SPSS version 13 and descriptive statistics.
Results:Male to female ratio was 1:1.7. Portosystemic shunt was performed for 16 patients (2 distal splenorenal, 10 central splenorenal, 2 portocaval, 2 mesocaval) and 3 underwent splenectomy. Of patients 2 complicated with pneumonia after a week, and 2 with encephalopathy. After at least one year, 66.6% of shunts were patent, 8% were closed and in 25.4% doppler ultra sonography could not localize the shunt. One patient died under surgery. There was no death at the end of the first year; but during a 6 years follow up, 6 mortalities occurred.
Conclusion: The major etiology of portal hypertension in these patients was cirrhosis secondary to hepatitis B. This finding is due to the cultural and religious differences with other countries. There was no relationship between pneumonia and splenectomy (p= 0.45). Also, no significant difference observed between pre and post surgery encephalopathy (p =0.14). Mortality rate did not depend on pre (p= 0.09) and post (p= 0.11) surgery encephalopathy. Survival rate of patients was 94.7% after one year and 73.7% after 2 years, demonstrating better results in comparison with other similar studies.

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References

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medical journal of mashhad university of medical sciences
Volume 50, Issue 3 - Serial Number 3
September and October 2007
Pages 253-258

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