Surgical management of the Budd-Chiari syndrome: early experience.
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1999-04-13
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Abstract
BACKGROUND: Early decompression is needed in the Budd-Chiari syndrome (BCS) to prevent liver dysfunction and death. AIMS: To study the technical difficulties during surgery and the results of surgery for BCS.
METHODS: Retrospective review of nine patients operated on between 1994 and January 1998 for BCS--1 for uncontrolled fundal variceal bleed and 8 for chronic BCS. Isolated hepatic vein block was found in 5, inferior vena cava (IVC) block in 1 and a combination in 3 patients. Preoperative liver biopsies did not reveal cirrhosis in any patient. Portacaval shunt (3), portorenal shunt (2), mesocaval shunt (1), mesoatrial shunt (2) and devascularisation (1) were the operations performed.
RESULTS: In 3 patients, side-to-side portacaval shunt was not possible because of caudate lobe hypertrophy (1), aberrant right hepatic artery (1) and presence of IVC stent (1); they required portorenal (2) or interposition mesocaval (1) shunts. Both mesoatrial shunts were unsuccessful. Devascularisation was effective in controlling the acute bleed. There was no intraoperative death. Postoperatively there were 3 deaths. Of the 6 survivors, 5 are asymptomatic over a mean follow up of 19.7 months.
CONCLUSIONS: Side-to-side portacaval shunt is effective in the management of BCS; results with the mesoatrial shunt are disappointing.
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Shah SR, Narayanan TS, Nagral SS, Mathur SK. Surgical management of the Budd-Chiari syndrome: early experience. Indian Journal of Gastroenterology. 1999 Apr-Jun; 18(2): 60-2