The incidence of shunt occlusion following portosystemic decompression

The English literature on portosystemic decompression procedures was reviewed for an 11 year period and is available upon request to the authors. Information on 1,586 end-to-side portacaval shunts, 308 side-to-side portacaval shunts, 550 standard splenorenal shunts, 436 interposition shunts, 319 distal splenorenal shunts and 136 direct mesocaval shunts was obtained. Operative mortality ranged from a low of 6% in patients undergoing a direct mesocaval shunt to a high of 29% among patients undergoing a side-to-side portacaval shunt. The incidence of portosystemic encephalopathy ranged from a low of 2% for direct mesocaval shunts to a high of 36% for side-to-side portacaval shunts. The occlusion rate was 18% for the standard splenorenal shunt, 10% for the distal splenorenal and interposition shunts, 7% for the direct mesocaval and the end-to-side portocaval shunts and 2% for the side-to-side portacaval shunt.