To test the hypothesis that partial portal decompression in the treatment of variceal hemorrhage will diminish subsequent encephalopathy, 50 consecutive patients were studied after construction of a small-stoma (10 to 12 mm) side-to-side portacaval shunt, with the goal of a postoperative portacaval pressure gradient of 10 mm Hg. During follow-up averaging 26 months, six patients (12 percent) died. Four patients (8 percent) had episodes of rebleeding, only one from varices. All patients had patent shunts at subsequent angiography or ultrasonography. Despite consistent (100 percent) postoperative reversal or stagnation of portal flow on duplex scan, encephalopathy on clinical and psychometric grounds was observed in only three patients (6 percent). This study suggests that small-stoma portacaval shunt can be performed with reliably low rates of rebleeding and encephalopathy. That encephalopathy was rare despite loss of hepatic portal perfusion incriminates other factors besides portal flow in the genesis of postshunt hepatic failure.
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