Chirurgie generalaPartial Portacaval Shunts in Bleeding Esophageal Varices in Cirrhotic Patients

Articol din publicatia Timisoara Medical Journal nr. 3/2005
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Octavian Cretu[1], Florin E. Hut[1], Laurentiu V. Sima[1], Dan Iliescu[1], Ovidiu Burlacu[2], Razvan Tarziu[1], Alexandru Blidisel[1], Vladimir Fluture[1]

1. Hepatic Surgery Department, Surgery Clinic
2. Thoracic Surgery Clinic, Timisoara Clinical Emergency City Hospital, Victor Babes University of Medicine and Pharmacy, Timisoara

Objective: to present "H" partial porto-caval shunt, as an eficient treatment for superior digestive hemorrhages due to esophageal varices rupture, which recurred after endoscopic treatment.

Material and method: the paper presents the authors experience regarding partial porto-caval shunt performed on seven cirrhotic pacients, Child-Pugh B risk class, with HTP 2B stage, which presented a hemorrhagic recurrence after endoscopic treatment. 10 mm diametre gore-tex prosthetics were used in six cases and 6 mm diametre gore-tex prosthetic, in one patient. Results: Immediate postoperative evolution and evolution in six months was considered favorable, when there were no signs of portal encephalopathy or hemorrhagic recurrence; this was the case in of five of the patients in which a 10 mm diametre gore-tex prosthetics was used. One patient with 10 mm diametre gore-tex prosthetic presented a immediate postoperative cardio-respiratory arrest, resuscitated, which leaded to trombosis of the shunt and relapsment of the hemorrhage, requiring transfer to another emergency service for TIPS. The 6 mm diametre gore-tex prosthetic, repeated the hemorrhage in the fifth postoperative day, fact that could not be controled and eventually leaded to the death of the patient. All six patients on which shunts with 10 mm prosthetics were performed had a good folloow up at 6 months, without any hemorrhagic recurences (except one patient after TIPS) or encephalopathy episodes.

Conclusions: partial porto-caval shunt, with 10 mm diametre gore-tex prosthetics is as an eficient treatment method of recurrenced superior digestive hemorrhages in cirrhotic patients with HTP.