Abstracts
1997 Digestive Disease Week

Small diameter prosthetic H-graft portacaval shunts in 110 patients: definitive therapy for variceal bleeding.

AS Rosemurgy, F Serafini, E Zervos, S Goode. Division of Surgical Digestive Disorders, University of South Florida, Tampa, FL.

Partial portal decompression, as attained by TIPS or small diameter prosthetic H-graft portacaval shunt (HGPCS), has become a popular option in the treatment of complicated portal hypertension. Large series of TIPS note the vigilance necessary to maintain shunt function by reporting "assisted" patency while similar series evaluating outcome after HGPCS have not been reported. Herein we report long term follow-up of 110 consecutive patients undergoing HGPCS. Methods: 110 patients underwent HGPCS through protocol from 1988-96, 53 before 1992. Prospective follow-up recorded efficacy, shunt patency, and survival. Results: 70 males / 40 females, average age 54±12.7 years, underwent shunting. Cirrhosis was due to alcohol in 64%, hepatitis in 12%, both in 4%, unknown causes in 14%, and miscellaneous causes in 6%. Child's class was A in 14%, B in 55%, and C in 31%. Shunts were undertaken emergently in 20%, urgently in 13%, and electively in 67%. Shunting decreased portal pressures (32mm Hg ± 5.0 to 19mm Hg ± 5.4, p<0.001). Perioperative mortality was 11.8% (6% Child's class A, 7% B, 21% C).

 Encephalopathy    Ascites    Rebleed   Thrombosis    Survival
  pre   post      pre   post                        3 year   5 year
  19%    25%      67%    30%    5.4%       3.6%      53%      58%

Conclusions: HGPCS achieve partial portal decompression. In contrast to reported results with TIPS, rebleeding and shunt occlusion are uncommon. Long term actuarial survival with minimal intervention in this series of older, high risk, alcoholic cirrhotics supports the application of HGPCS.