Mesocaval shunt using external iliac vein interposition graft as an alternative to TIPSS
Gupta, S.; Soin, A.S.; Singhal, D.; Somashekar, U.; Verma, V.; Kumar, M. and Nundy, S. (2002) Mesocaval shunt using external iliac vein interposition graft as an alternative to TIPSS. Journal of Gastroenterology and Hepatology(2002) 17 (Supp.); A74, 17 (Suppl. A74).
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Background: The expertise for TIPSS is not easily available in India. As opposed to a covered stent, which is quite expensive, the ordinary stent occludes easily. Therefore if a surgical portosystemic shunting could be done with low morbidity and lower one time cost, it would be a good alternative for patients with early cirrhosis. Patients and methods: The three patients in the study include one each with recurrent fundal variceal bleed on a background of Child's A cirrhosis, hepatic vein outflow obstruction (HVOO), and blocked lieno-renal shunt. A midline incision was used to expose the IVC and SMV. The segment of right external iliac vein from just above the inguinal ligament to the internal iliac vein was harvested and used as an interposition graft between the IVC and the SMV. Results: Patient 1, after initial worsening of ascites, made a good recovery and is well at 9 month follow up without ascites and with a patent graft. The second patient has no evidence of HVOO and the caudate lobe has shrunk remarkably at 6- month follow-up. The third patient has had no further bleed at 3-month follow-up. The average blood loss was 2 units during the procedure. No patient required post-operative ICU care. All patients had transient ipsilateral leg edema which subsided over 2-4 weeks. The average cost of this surgical shunt was about 50% of the TIPSS procedure using a PTFE covered stent in our institution. Conclusions: Mesocaval shunt using external iliac vein interposition graft is a viable alternative to TIPSS and gives excellent results in patients with stable liver disease with refractory ascites or recurrent variceal bleed.
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