DISTAL SPLENORENAL SHUNT VERSUS PORTOCAVAL SHUNT (SARFEH) FOR THE MANAGEMENT OF SCHISTOSOMAL VARICEAL BLEEDING | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 22, Issue 4, October 2003, Page 359-369 PDF (432.46 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejsur.2003.374250 | ||||
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| Authors | ||||
| Habashi A. El-Hammadi; Mahmoud F. Sakr* ; Mohamed M. Moussa; Mosaad M. Hemaidh; Yasser M. Hamza; Mohamed Abdel Kader; Magdy M. El-Sharaky | ||||
| Department of Surgery, Faculty of Medicine, University of Alexandria, Egypt | ||||
| Abstract | ||||
| Objectives: This prospective, controlled randomized study was designed to compare distal splenorenal shunt (DSRS) and 8-mm diameter portocaval shunt (Sarfeh) with extensive collateral ligation (PCS-CL) in the elective management of Child-Pugh class A and B schistosomal variceal bleeders. Subjects and Methods: Thirty-six patients had DSRS and 38 had PCS-CL. Both groups were similar preoperatively regarding their clinical, biochemical, endoscopic and hemodynamic profiles. Patients were re-evaluated at two weeks and one year after surgery. Mean follow-up was 38.6 months. Results: DSRS had a significantly higher operative index than PCL-CL (5.08 ±2.33 vs 1.57±0.74). No differences were observed regarding operative mortality (2.77% vs 2.63%), morbidity including ascites and encephalopathy, and survival (91.6% vs 92.1%). Rebleeding occurred more frequently after PCS-CL (15.79%) compared to DSRS (11.11%). At one year postoperatively, DSRS resulted in complete eradication of gastric varices and significant reduction of esophageal variceal size more than PCS-CL (P<0.05). Splenic size was significantly reduced after DSRS but not after PCS-CL (P<0.05). Colored duplex showed that both procedures significantly reduced portal vein flow volume and diameter, and maintained hepatopetal portal perfusion in all patients. Conclusions: In the schistosomal population (1) Both DSRS and PCS-CL have low operative mortality and morbidity, (2) Both procedures maintain portal perfusion, have good long-term patient survival, and very low incidence encephalopathy, (3) DSRS is superior regarding variceal eradication, reduction of the rate of re-bleeding, and decrease of splenic size, and (4) PCS-CL is a good alternative if DSRS were not feasible. | ||||
| Keywords | ||||
| Portosystemic shunt; portal hypertension; varices; schistosomal; hepatic fibrosis | ||||
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