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Volume 295:1089-1095 November 11, 1976 Number 20 Next

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Abstract

Two types of surgical therapy of bleeding esophageal varices were evaluated in 48 patients by a randomized controlled trial: 24 were randomized for a total shunt and 24 for the selective shunt. In two of the latter, a total shunt had to be performed for technical reasons. The fatality rates (six in the 24 total, and six in 22 selective [performed], and seven in 24 selective [randomized]), the frequency of shunt occlusion (two in each group), and of recurrent gastronintestinal bleeding (three in each group) were similar. Encephalopathy developed more often after a total shunt -- 10 of 24, or one per 58 patient-months -- than after selective (performed) -- one of 22, or one per 593 patient-months (P less than 0.005). Total shunts consistently diverted the hepatopetal mesenteric-portal flow from the liver. Deterioration of hepatic function (maximum rate of urea synthesis) was greater after total than selective shunt (P less than 0.05).

This article has been cited by other articles:

• Sparks, F. C., Maitem, A., Glickman, M. G., Tilson, M. D. (1982). Embolization of Bleeding Esophageal Varices via Umbilical Vein: An Alternative Approach. Arch Surg 117: 354-358 [Abstract]  
• Widrich, W. C., Johnson, W. C., Robbins, A. H., Nabseth, D. C. (1978). Esophagogastric Variceal Hemorrhage: Its Treatment by Percutaneous Transhepatic Coronary Vein Occlusion. Arch Surg 113: 1331-1338 [Abstract]