Three decades of experience with emergency portacaval shunt for acutely bleeding esophageal varices in 400 unselected patients with cirrhosis of the liver

M. J. Orloff, M. S. Orloff, Susan Orloff, M. Rambotti, B. Girard

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

BACKGROUND: Emergency treatment of acute bleeding is of singular and paramount importance in the therapy of portal hypertension and esophagogastric varices. Accordingly, for more than three decades we have conducted prospective studies of emergency therapy, and particularly of emergency portacaval shunt (EPCS). STUDY DESIGN: Emergency portacaval shunt was performed upon 400 patients with cirrhosis of the liver and acutely bleeding esophagogastric varices according to three principles: operation within eight hours of initial contact; unselected patients, meaning that no patient with variceal bleeding caused by hepatic disease was excluded from EPCS, and prospective study, meaning that a well-defined protocol was consistently used and data were collected on-line. Patients were divided into an early group of 180 treated from 1963 to 1978 and a recent group of 220 treated from 1978 to July, 1990, with similar characteristics, but strikingly different outcome. Follow-up rates at one, five, and ten years were 100, 98, and 97 percent, respectively; 96 percent of patients underwent EPCS five or more years ago. Proof of acute variceal bleeding and of cirrhosis of the liver (alcoholic in 95 percent) was obtained in every patient. Child's risk classes determined quantitatively were A in 11 percent of the patients, B in 65 percent, and C in 24 percent. All patients had a direct portacaval shunt, side-to-side in 85 percent, which reduced the mean portal vein to inferior vena cava pressure gradient from 271 to 21 mm saline solution. RESULTS: All but four patients (99 percent) had immediate and permanent control of variceal bleeding. Thrombosis of the shunt occurred in only two patients (0.5 percent). Survival rates at 30 days, five years, ten years, and 15 years in the early group were 58, 40, 30, and 30 percent, respectively, while in the recent group they were 85, 78, 71, and 57 percent, respectively (p

Original languageEnglish (US)
Pages (from-to)257-272
Number of pages16
JournalJournal of the American College of Surgeons
Volume180
Issue number3
StatePublished - 1995
Externally publishedYes

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Surgical Portacaval Shunt
Esophageal and Gastric Varices
Liver Cirrhosis
Emergencies
Hemorrhage
Emergency Treatment
Varicose Veins
Prospective Studies
Alcoholic Liver Cirrhosis
Inferior Vena Cava
Portal Hypertension
Portal Vein
Sodium Chloride
Thrombosis
Survival Rate

ASJC Scopus subject areas

  • Surgery

Cite this

Three decades of experience with emergency portacaval shunt for acutely bleeding esophageal varices in 400 unselected patients with cirrhosis of the liver. / Orloff, M. J.; Orloff, M. S.; Orloff, Susan; Rambotti, M.; Girard, B.

In: Journal of the American College of Surgeons, Vol. 180, No. 3, 1995, p. 257-272.

Research output: Contribution to journalArticle

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