modified warren shunt by using 8-mm interposition Gore-Tex graft

ABSTRACT

Thirty nine patients with oesophageal varices were included in the work. All patients have a history of at least one attack of bleeding oesophageal varices. Patients were operated upon by a modified distal splenorenal splenorenal shunt using 8mm. interposition Gore- Tex Graft. The operations were urgent in 9 and elective in 30 patients, 29 patients were males and 10 were females, age ranged from 18 to 58 years with a mean age of 32 years, 14 patients have bilharzial periportal fibrosis, 8 patients have chronic active hepatitis and 17 patients have combined pathology of chronic hepatitis and bilharzial periportal fibrosis, 24 patients were in child's class A, 14 patients in class B and 1 class C. Emergency shunts were performed only when conservative therapy had failed to stop variceal bleeding; 2 patients died in the elective group [6.7%] due to hepatic failure and 2 patients died in the emergency group [22.2%]. One due to hepatic failure and the second of haemorrhage. Patients were followed up for 6 to 48 months, shunts were found to be patent in 30 patients [85.7%] and thrombosis was found in 5 patients [14.2%], recurrence of bleeding occured in 4 patients [11.4%.]. Patients who showed thrombosis or rebleeding were treated by sclerotherepy in 3 patients, splenectomy and devascularization in 2 patients, one of them died of hepatic failure, temporary encephalopathy occurred in 3 and ascites in 2. It can be concluded that modified distal splenorenal shunt using an 8mm. interposition Gore-Tex H- Graft is a reliable operative method in the treatment of bleeding oesophageal varices as it is technically less demanding operation with less blood loss and shorter operating time. The high venous flow in the portal circulation in portal hypertension can prevent occlusion of the graft but pressure measurements during surgery is a must to assure this high flow rate along the graft