507 Warren-Zeppa distal splenorenal shunts: A 34-year experience

Alan S. Livingstone, Leonidas Koniaris, Eduardo A. Perez, Nicholas Alvarez, Joe U. Levi, Duane G. Hutson

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

OBJECTIVE: To define the long-term characteristics, prognostic factors, and outcomes of patients undergoing selective splenorenal shunting procedures for portal hypertension-induced recurrent upper gastrointestinal bleeding. MATERIALS AND METHODS: A retrospective evaluation of a prospectively collected data set. RESULTS: From June 1971 through May 2005, 507 Warren-Zeppa shunts were performed at a single institution. Indications included: alcoholic cirrhosis, 52.6%; viral cirrhosis, 21.8%; cryptogenic cirrhosis, 8.4%; autoimmune cirrhosis, 5.8%; and other causes, 6.3%. Median survival was 81 months (5-year survival, 58.9%; 10-year survival, 34.4%; 20-year survival, 12.5%). patients with portal vein thrombosis and biliary cirrhosis demonstrated better survival than others (P = 0.03), while patients with alcoholic cirrhosis trended toward worse survival than those with nonalcoholic causes (P = 0.11). Multivariate analysis of preoperative risk factors found body hair loss (hazard ratio, 17.3; P > 0.005), preoperative encephalopathy (hazard ratio, 1.93; P > 0.003), diuretic use (hazard ratio, 1.43; P > 0.003), and age (hazard ratio, 1.02 per year of age; P > 0.051) were independent predictors of poor long-term survival. Multivariate analysis of operative factors demonstrated blood loss 0.001) was the only independent predictor of poor prognosis. CONCLUSIONS: The Warren-Zeppa shunt provides long-term survival and control of bleeding in most patients with portal hypertension. Excellent long-term survival can be obtained in properly selected patients with portal hypertension and relatively spared hepatic function.

Original languageEnglish (US)
Pages (from-to)884-892
Number of pages9
JournalAnnals of Surgery
Volume243
Issue number6
DOIs
StatePublished - Jun 2006
Externally publishedYes

Fingerprint

Surgical Splenorenal Shunt
Survival
Portal Hypertension
Alcoholic Liver Cirrhosis
Fibrosis
Multivariate Analysis
Hemorrhage
Biliary Liver Cirrhosis
Alopecia
Brain Diseases
Portal Vein
Diuretics
Thrombosis

ASJC Scopus subject areas

  • Surgery

Cite this

Livingstone, A. S., Koniaris, L., Perez, E. A., Alvarez, N., Levi, J. U., & Hutson, D. G. (2006). 507 Warren-Zeppa distal splenorenal shunts: A 34-year experience. Annals of Surgery, 243(6), 884-892. https://doi.org/10.1097/01.sla.0000219681.08312.87

507 Warren-Zeppa distal splenorenal shunts : A 34-year experience. / Livingstone, Alan S.; Koniaris, Leonidas; Perez, Eduardo A.; Alvarez, Nicholas; Levi, Joe U.; Hutson, Duane G.

In: Annals of Surgery, Vol. 243, No. 6, 06.2006, p. 884-892.

Research output: Contribution to journalArticle

Livingstone, AS, Koniaris, L, Perez, EA, Alvarez, N, Levi, JU & Hutson, DG 2006, '507 Warren-Zeppa distal splenorenal shunts: A 34-year experience', Annals of Surgery, vol. 243, no. 6, pp. 884-892. https://doi.org/10.1097/01.sla.0000219681.08312.87
Livingstone, Alan S. ; Koniaris, Leonidas ; Perez, Eduardo A. ; Alvarez, Nicholas ; Levi, Joe U. ; Hutson, Duane G. / 507 Warren-Zeppa distal splenorenal shunts : A 34-year experience. In: Annals of Surgery. 2006 ; Vol. 243, No. 6. pp. 884-892.
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abstract = "OBJECTIVE: To define the long-term characteristics, prognostic factors, and outcomes of patients undergoing selective splenorenal shunting procedures for portal hypertension-induced recurrent upper gastrointestinal bleeding. MATERIALS AND METHODS: A retrospective evaluation of a prospectively collected data set. RESULTS: From June 1971 through May 2005, 507 Warren-Zeppa shunts were performed at a single institution. Indications included: alcoholic cirrhosis, 52.6{\%}; viral cirrhosis, 21.8{\%}; cryptogenic cirrhosis, 8.4{\%}; autoimmune cirrhosis, 5.8{\%}; and other causes, 6.3{\%}. Median survival was 81 months (5-year survival, 58.9{\%}; 10-year survival, 34.4{\%}; 20-year survival, 12.5{\%}). patients with portal vein thrombosis and biliary cirrhosis demonstrated better survival than others (P = 0.03), while patients with alcoholic cirrhosis trended toward worse survival than those with nonalcoholic causes (P = 0.11). Multivariate analysis of preoperative risk factors found body hair loss (hazard ratio, 17.3; P > 0.005), preoperative encephalopathy (hazard ratio, 1.93; P > 0.003), diuretic use (hazard ratio, 1.43; P > 0.003), and age (hazard ratio, 1.02 per year of age; P > 0.051) were independent predictors of poor long-term survival. Multivariate analysis of operative factors demonstrated blood loss 0.001) was the only independent predictor of poor prognosis. CONCLUSIONS: The Warren-Zeppa shunt provides long-term survival and control of bleeding in most patients with portal hypertension. Excellent long-term survival can be obtained in properly selected patients with portal hypertension and relatively spared hepatic function.",
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AU - Levi, Joe U.

AU - Hutson, Duane G.

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N2 - OBJECTIVE: To define the long-term characteristics, prognostic factors, and outcomes of patients undergoing selective splenorenal shunting procedures for portal hypertension-induced recurrent upper gastrointestinal bleeding. MATERIALS AND METHODS: A retrospective evaluation of a prospectively collected data set. RESULTS: From June 1971 through May 2005, 507 Warren-Zeppa shunts were performed at a single institution. Indications included: alcoholic cirrhosis, 52.6%; viral cirrhosis, 21.8%; cryptogenic cirrhosis, 8.4%; autoimmune cirrhosis, 5.8%; and other causes, 6.3%. Median survival was 81 months (5-year survival, 58.9%; 10-year survival, 34.4%; 20-year survival, 12.5%). patients with portal vein thrombosis and biliary cirrhosis demonstrated better survival than others (P = 0.03), while patients with alcoholic cirrhosis trended toward worse survival than those with nonalcoholic causes (P = 0.11). Multivariate analysis of preoperative risk factors found body hair loss (hazard ratio, 17.3; P > 0.005), preoperative encephalopathy (hazard ratio, 1.93; P > 0.003), diuretic use (hazard ratio, 1.43; P > 0.003), and age (hazard ratio, 1.02 per year of age; P > 0.051) were independent predictors of poor long-term survival. Multivariate analysis of operative factors demonstrated blood loss 0.001) was the only independent predictor of poor prognosis. CONCLUSIONS: The Warren-Zeppa shunt provides long-term survival and control of bleeding in most patients with portal hypertension. Excellent long-term survival can be obtained in properly selected patients with portal hypertension and relatively spared hepatic function.

AB - OBJECTIVE: To define the long-term characteristics, prognostic factors, and outcomes of patients undergoing selective splenorenal shunting procedures for portal hypertension-induced recurrent upper gastrointestinal bleeding. MATERIALS AND METHODS: A retrospective evaluation of a prospectively collected data set. RESULTS: From June 1971 through May 2005, 507 Warren-Zeppa shunts were performed at a single institution. Indications included: alcoholic cirrhosis, 52.6%; viral cirrhosis, 21.8%; cryptogenic cirrhosis, 8.4%; autoimmune cirrhosis, 5.8%; and other causes, 6.3%. Median survival was 81 months (5-year survival, 58.9%; 10-year survival, 34.4%; 20-year survival, 12.5%). patients with portal vein thrombosis and biliary cirrhosis demonstrated better survival than others (P = 0.03), while patients with alcoholic cirrhosis trended toward worse survival than those with nonalcoholic causes (P = 0.11). Multivariate analysis of preoperative risk factors found body hair loss (hazard ratio, 17.3; P > 0.005), preoperative encephalopathy (hazard ratio, 1.93; P > 0.003), diuretic use (hazard ratio, 1.43; P > 0.003), and age (hazard ratio, 1.02 per year of age; P > 0.051) were independent predictors of poor long-term survival. Multivariate analysis of operative factors demonstrated blood loss 0.001) was the only independent predictor of poor prognosis. CONCLUSIONS: The Warren-Zeppa shunt provides long-term survival and control of bleeding in most patients with portal hypertension. Excellent long-term survival can be obtained in properly selected patients with portal hypertension and relatively spared hepatic function.

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