{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T14:35:44Z","timestamp":1761662144624},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2003,12,5]],"date-time":"2003-12-05T00:00:00Z","timestamp":1070582400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2004,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The role of a massive spontaneous portosystemic shunt (MSPSS) in cirrhotic patients with portal hypertension remains unclear. The aim of this study was to investigate clinical outcomes and portal hemodynamic changes following ligation of the MSPSS during devascularization surgery. Portography and gastroendoscopy were performed before and after surgery for hemodynamic and follow\u2010up studies. Three types of MSPSS were demonstrated portographically: 22 portoumbilical shunts, 18 splenorenal shunts, and 2\u00a0inferior mesenteric\u2010caval shunts. A total of 40\u00a0MSPSS patients with esophagogastric variceal (EGV) bleeding underwent surgery: 26 had ligation of the MSPSS, and the remaining 14 served as the nonligation group. Neither the preoperative mean portal pressure (MPP) nor the postoperative MPP were significantly different between the ligation and nonligation groups (<jats:italic>p<\/jats:italic> &gt; 0.1), and there was no significant difference regarding surgical mortality, recurrent varices, or cumulative survival rate for the two groups in the follow\u2010up study. However, postoperative portography demonstrated persistent drainage of portal flow and decreased intrahepatic portal perfusion in the nonligation patients. Clinical signs of hepatic encephalopathy subsided after ligation of the MSPSS in three patients. Therefore ligation of the MSPSS, which may be responsible for the development of encephalopathy, is recommended during devascularization surgery for EGV in cirrhotic patients.<\/jats:p>","DOI":"10.1007\/s00268-003-7068-7","type":"journal-article","created":{"date-parts":[[2004,7,22]],"date-time":"2004-07-22T08:50:28Z","timestamp":1090486228000},"page":"23-28","source":"Crossref","is-referenced-by-count":12,"title":["Effect of Spontaneous Portosystemic Shunts on Hemorrhage from Esophagogastric Varices"],"prefix":"10.1002","volume":"28","author":[{"given":"Jan\u2010Sing","family":"Hsieh","sequence":"first","affiliation":[{"name":"Department of Surgery Kaohsiung Medical University No. 100, Shih Chuan 1st Road 807 Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaw\u2010Yuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Surgery Kaohsiung Medical University No. 100, Shih Chuan 1st Road 807 Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Che\u2010Jen","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Surgery Kaohsiung Medical University No. 100, Shih Chuan 1st Road 807 Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fang\u2010Ming","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Surgery Kaohsiung Medical University No. 100, Shih Chuan 1st Road 807 Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsung\u2010Jen","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Surgery Kaohsiung Medical University No. 100, Shih Chuan 1st Road 807 Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2003,12,5]]},"reference":[{"key":"e_1_2_8_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004836-198606000-00006"},{"key":"e_1_2_8_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-195909000-00006"},{"key":"e_1_2_8_4_2","first-page":"654","article-title":"Natural porto\u2010systemic venous shunts in portal hypertension","volume":"80","author":"Hamilton LC","year":"1961","journal-title":"Med. 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