Differential portal pressures in relation to prognosis and to survival of patients undergoing portacaval shunt

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IN patients with cirrhosis of the liver and portal hypertension, hemorrhage from esophageal varices is a major cause of death. A portacaval shunt provides excellent protection against recurrent episodes of hemorrhage, and is our preferred procedure for decompression of the portal venous system.

The operative mortality from shunt procedures, however, continues to be from 10 to 15 percent,1–3 and postoperative complications, particularly chronic hepatic encephalopathy, may be difficult and distressing to manage. The importance of careful selection of patients who will survive the operation and regain satisfactory function of the liver must be repeatedly emphasized. We are continuing to seek means to improve our selection of patients for portal-systemic shunt operations.

Factors that have been shown to influence survival and prognosis in patients undergoing portacaval shunt include the preoperative functional status of the liver, the histologic type of cirrhosis, the age of the patient, and whether the operation can be performed as an elective procedure or must be done under emergency circumstances.4 Another factor that has been considered to affect prognosis is the hemodynamics of the portal venous system measured at the time of operation.5–8

This report presents a study of differential portal pressures measured at operation in a group of 77 patients who underwent portacaval shunts at the Cleveland Clinic Hospital, and evaluates these findings in relation to prognosis and to survival of the patients.

Clinical Material and Methods

The 77 patients (39 men and 38 women) included in this study were selected from 125 patients in whom portal-systemic . . .



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