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Alternative use of the interposition Dacron grafts in the treatment of portal hypertension. Clinical experience with 28 cases.

Twenty-eight patients suffering from esophageal bleeding due to portal hypertension were submitted to an "H" type shunt utilizing a 12 mm. wide knitted Dacron prosthesis. The series consists of 8 meso-caval, 12 porto-caval 8 spleno-renal shunts. Thrombosis of the spleno-portal axis was the main indication for the mesocaval shunt, while side-to-side porto-caval and spleno-renal "H" anastomoses were carried out in patients in whom enlarged lymphatics, edema of the porta hepatis or a too large gap between the two veins precluded the use of a direct shunt. The overall mortality rate was 7% including one operative and one late death. The long-term follow-up study included 26 patients and ranged from 6 to 34 months. In all patients patency of the shunt was evaluated by barium swallow x-ray and esophagogastroscopy. Four of them were further investigated by angiography. A good patency of the shunt was demonstrated in all cases. There was no recurrence of the variceal bleeding either in the post-operative period nor in the long-term follow-up. On the basis of our results we feel that the use of Dacron grafts as "H" type shunts is an effective alternative method in relieving portal hypertension in patients in whom it is difficult or impossible to perform a direct anastomosis and further this procedure can be extended with encouraging results to side-to-side spleno-renal shunts.