Mesentericocaval shunt with the internal jugular vein

Seventy nine mesocaval shunts using the internal jugular vein and 54 side to side portocaval shunts have been performed during the past 6 yr. Patients were evaluated from the standpoint of protection from recurrent bleeding, patency of the shunt, encephalopathy, rehabilitation and long term survival. All of the patients underwent followup observation. In a selected group of patients, postoperative angiographic control was performed, and serum levels of octopamine were examined. In the mesentericocaval group, patency of the shunt was demonstrated in 82%, the incidence of encephalopathy was 35% and the long term survival rate, as computed by the actuarial method, was 65%. In the portocaval group, the incidence of encephalopathy was 54% and the survival rate, 38%. There was no correlation between octopamine serum levels and encephalopathy. Persistent perfusion of the liver was documented in 95% of the patients controlled by arteriography in the mesentericocaval group with patent shunts. The mesentericocaval shunt seems to be an effective technique in terms of incidence of encephalopathy and survival rate, but a randomized study will be necessary to prove that this technique is more effective than the standard portocaval shunt.