[Small diameter porto-caval shunt in patients with bleeding from esophageal varices: a report of twenty cases].

INTRODUCTION

SDPCS (The small diameter portacaval shunt) published originally by Rypins and Sarfeh in Los Angeles in 1983 has recieved little attention in our comunity to control bleeding in patients with portal hypertention. The bleeding of esophageal varices represents the must frequent and dramatic complication caused by cirrhosis, with a 50% of mortality without treatment.

BACKGROUND

Comunicate the indications, thecnique and results with the Small Diameter Portocaval shunt.

METHODS

Prospective trial from April 1992 to November 1998. Twenty patients with bleeding esophageal varices, 6 female, 14 male, ages 31-72 years;

ETIOLOGY: Alcoholic Cirrhosis 7 patients; Hepatitis B virus 4 patients, Criptogenic 4 patients, Child A; 13 patients, Child B; 5 patients and Child B-C 2 patients. Direct intraoperatory Inferior Vena Cava and portal pressures was obteined in all cases.14 grafs 10 mm and 6, 8 mm Polytetrafiuoroetehilene (PTFE) grafts were used .

RESULTS

Follow up 6 to 68 months; Mortality 5%, morbidity 5%, rebleeding 15%, graft trhombosis 10%, encephalopathy: Mild 5%, Moderated 5%, Severe 10%. Mean surgical time 4.28 h. Mean blood transfussion 1.4 units of red blood cells. The venous pressure pre and post grafting decreased significantly p < 0.01.

CONCLUSIONS

SDPCS is a easy to apply procedure and results are addecuate; it requires an specialized preoperatory ultrasound. The descensus in portal pressure after grafting and graf permeability was corroborated.