The emergency portacaval H graft in alcoholic cirrhotic patients: influence of shunt diameter on clinical outcome.

Emergency partial portal decompression was achieved with 8 or 10 mm portacaval H graft shunts combined with aggressive collateral ligation in 18 patients in whom bleeding esophageal varices could not be controlled medically. They were compared with 11 similar risk patients undergoing larger diameter portacaval H graft shunts (12 to 14 mm) for the same indications. Variables studied included 90 day operative mortality, hepatic encephalopathy rates, corrected portal pressure, and variceal re-bleeding. Operative mortality was similar in both groups and correlated strongly with Child's class. However, the incidence of portasystemic encephalopathy in survivors was significantly lower after partial decompression than after total decompression. No patient in either group rebled from varices. We conclude from our series of high risk alcoholic cirrhotic patients, that although mortality after partial and total portal decompression is similar, the lower incidence of encephalopathy in survivors suggests that partial decompression has advantages over total decompression when emergency control of variceal bleeding is necessary.