END TO SIDE VERSUS SIDE TO SIDE PORTACAVAL SHUNTS IN PATIENTS WITH HEPATIC CIRRHOSIS

1. 1. One hundred and two consecutive patients in whom either end to side or side to side portacaval shunts were fashioned were followed up for as long as eight years. All patients had had hemorrhage from gastroesophageal varices secondary to either portal or postnecrotic cirrhosis. 2. 2. Patients were classified into three risk groups according to estimated hepatic reserve using previously defined criteria. Such a classification system is essential for any comparative analysis of patients with hepatic cirrhosis. 3. 3. Operative mortality was 10 per cent for good risk, 16 per cent for moderate risk, and 54 per cent for poor risk patients. Operative mortality was twice as great for poor risk patients with end to side shunts compared to poor risk patients with side to side shunts (p < 0.03). 4. 4. The probability of survival for five years was 42 per cent for good risk, 33 per cent for moderate risk, and 18 per cent for poor risk patients. Long-term survival was similar for the entire series of patients with either type of shunt, but tended to be better for patients with side to side shunts within each risk group. 5. 5. Significant chronic encephalopathy developed in fourteen patients, nine of whom had side to side shunts. Other complications occurred with approximately equal incidence in patients with either type of shunt. 6. 6. The side to side portacaval shunt is preferable to the end to side shunt in the poor risk patient because of a significantly lower operative mortality. © 1968.