Outcomes after extrahepatic portosystemic shunt ligation in 49 dogs
Article first published online: 10 MAR 2008
Australian Veterinary Journal
Volume 77, Issue 5, pages 303–307, May 1999
How to Cite
HUNT, G. and HUGHES, J. (1999), Outcomes after extrahepatic portosystemic shunt ligation in 49 dogs. Australian Veterinary Journal, 77: 303–307. doi: 10.1111/j.1751-0813.1999.tb10268.x
- Issue published online: 10 MAR 2008
- Article first published online: 10 MAR 2008
- Accepted for publication 2 November 1998
- extrahepatic portosystemic shunt;
- surgical outcomes.
ObjectiveTo evaluate outcomes after attenuation of extrahepatic portosystemic shunts in dogs using surgical silk. Design Retrospective study.
ProcedureCase records were reviewed for degree of surgical attenuation, experience of the primary surgeon, perioperative mortality and problems related to persistent portosystemic shunting or shunt ligation. Presence of portosystemic shunting after surgery was evaluated by ammonia tolerance testing, measurement of postprandial serum bile acid, plasma urea and cholesterol concentrations and liver enzyme activity. The influence of age, postocclusion portal pressure, primary surgeon, degree of attenuation and postoperative biochemical findings on the occurrence of postoperative problems was assessed.
ResultsThe mortality rate was 2.1%. Shunt attenuation was complete in 34% and partial in 66% of dogs. Portal hypertension necessitating ligature removal was encountered in only one dog. Five dogs experienced neurological abnormalities (seizures or ataxia), possibly as a manifestation of 'postligation seizure syndrome. Postoperative liver function was normal in 78% of dogs, including 70% with partial shunt attenuation. Experience of the surgeon was related positively to outcome after partial attenuation (P = 0.002). Postoperative biochemical evidence of abnormal liver function was the most sensitive predictor of recurrence of clinical signs referable to persistent portosystemic shunting.
ConclusionsIn the hands of an experienced surgeon, surgical attenuation of single extrahepatic shunts was safe and effective, even in animals with partial attenuation. Most dogs with biochemical evidence of persistent shunting suffer relapse of clinical signs within 18 months of surgery. Postligation neurological syndromes of variable intensity may be more common than previously thought.