ABSTRACT
Partial portacaval shunts, are distinct in concept and hemodynamics from selective and total shunts. The aim of this work was to evaluate the small diameter partial portacaval shunt operation [DDPPCs] as a definitive management for patients with bleeding esophageal varices from schistosomal hepatic fibrosis and portal hypertension. Thirty-three patients were studied. All patients were prepared for elective partial portacaval shunting using the eight mm. Polytetraflouroethylene [PTFE] Gortex graft. The preoperative work up included full hematological studies, liver and renal function tests, upper Gl endoscopy, with confirmation of variceal grade, abdominal coloured Duplex of the portal [P. V.], splenic [S. V.], and inferior vena cava [I. V.C.], all stigmata of amoniacal encephalopathy were looked for. Fourteen cases [42.42%] were of child's class A, and nineteen [57.57%] were of class B. Oesophageal varices were revealed in all cases with Grades III and IV in 69.69% of cases, and risk signs in 84.84% of cases. The mean diameter [D] of portal vein was 17.3+11 mm. The flow [F] in the portal vein was hepatopetal in all cases with a mean of 2.38+0.64L/minute. All patients after being subjected to SDPPCS operation were followed up for a period that ranged from 15 to 38 months. Postoperative findings, as well as data after one month and one year follow up are presented in this work. The shunt was completed successfully in 30 out of 33 patients, inspite of some operative difficulties which were found in 12 cases. There was no operative mortality. The early mortality rate [30 days after the operation] was 6.06% early thrombosis rate was 9.99%, and late occlusion rate was 3.3%, and rebleeding occurred in 2 cases 6.06%. The varices were down graded in 19 patients and disappeared in 6, while six patients refused follow up endoscopic evaluation. The flow in the shunt was directly visualized in 11 patients with a mean flow of 1.12+0.32 L/Min and 1.73+ 0.26 L/Min one month and one year respectively. The portal vein showed post operative hepatopetal flow that was reduced to 1.59 +/- 0.65 L/Min, and 1.12 +/- 0.51 L/Min one month and one year respectively. This reduction was mainly in the cephalic portion of the vein in comparison to increased flow in the caudal portion. The flow in the I. V.C was increased to 3.2 +/- 0.67 and 3.6 +/- 1.25 post operatively one month and one year postoperatively. There were no cases of hepatic encephalopathy