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International Journal of
Surgery Research and Practice ISSN: 2378-3397

Citation

Yi-Ju W, Chih-Che L, Yu-Hung L, Chao-Long C, Huang W, et al. (2018) An Alternative Mesofemoral Shunt for Uncontrolled Variceal Bleeding. Int J Surg Res Pract 5:086. doi.org/10.23937/2378-3397/1410086

Copyright

© 2018 Yi-Ju W, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

ORIGINAL ARTICLE | OPEN ACCESS DOI: 10.23937/2378-3397/1410086

An Alternative Mesofemoral Shunt for Uncontrolled Variceal Bleeding

Yi-Ju Wu1*, Chih-Che Lin1, Yu-Hung Lin1, Chao-Long Chen1, Wayne Huang2 and Yu-Feng Kao3

1Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

2Department of Surgery, Show Chwan Memorial Hospital, Chang-Hua, IRCAD, Taiwan

3Department of Nursing Care, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

Abstract

Background

Portal hypertension can lead to life-threatening variceal bleeding (VB). Transjugular intrahepatic portosystemic shunt (TIPSS) is the standard choice for uncontrolled VB. Unavailable for TIPSS, we design a mesofemoral shunt (MFS) as an alternative method for control of VB.

Methodology

From March 2011 to November 2014, eleven patients with VB due to liver cirrhosis were enrolled. The MFS was created by connecting from superior mesenteric vein below transverse colon, via subcutaneous tunnel, to right femoral vein with an 8-mm diameter polytetrafluoroethylene (PTFE) graft.

Results

The median follow-up was 13 months (range, 2~44 months). The MFS was successful in 11 (100%) hemostasis. One patient died of surgical mortality and the other due to liver failure 6 months after MFS. The PTFE occlusion was documented by ultrasonography in 4 (36%) patients. Two (18%) developed recurrent bleeding, which was treated by surgical thrombectomy. Nine patients, including 2 bridged to LT, were alive.

Conclusion

The MFS is an effective and considerable shunt procedure to control VB in the situation of unavailable for TIPSS. The subcutaneous tunnel of MFS could also be managed as surgical thrombectomy.