{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T14:40:16Z","timestamp":1737729616659,"version":"3.33.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":5540,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2000,7]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>Small-diameter portacaval H-graft (SDPHG) shunts are partial portosystemic shunts that control variceal bleeding while preserving nutrient blood flow to the liver, minimizing postoperative encephalopathy and liver failure. Since July 1, 1997, we placed SDPHG shunts in 18 patients (age, 52.1 \u00b1 2.6 years; range, 35 to 72 years) with cirrhosis (Child\u2019s class A, B, and C in 6, 10, and 2 patients, respectively) and refractory variceal bleeding who were not candidates for transplantation. Ten procedures (55.6%) were urgent or emergent. SDPHG shunts effectively reduced the portacaval pressure gradient (18 \u00b1 3 <jats:italic toggle=\"yes\">v<\/jats:italic> 5 \u00b1 2 mm Hg; <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; .05). Surgical times (210 \u00b1 11 minutes), estimated blood losses (358.3 \u00b1 107.8 mL), transfusion requirements (0 transfusions in 10 patients; 55.6% mean, 0.9 \u00b1 0.3 units), and postoperative hospitalization (7.7 \u00b1 1.0 days) were excellent. Surgical mortality (30 days) was 0%. During 14.0 \u00b1 1.9 months (range, 1.1 to 29.1 months) of follow-up, 4 patients (22.2%) died, including both patients with Child\u2019s class C cirrhosis. The cumulative 1-year survival rate was 82.1% (Child\u2019s class A, B, and C, 83.3%, 90%, and 0%, respectively). Long-term survivors had significantly lower preoperative Child-Pugh scores compared with nonsurvivors (7.8 \u00b1 0.3 <jats:italic toggle=\"yes\">v<\/jats:italic> 9.5 \u00b1 1.0; <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; .05). Postoperative encephalopathy developed in 3 survivors (20%). Fifteen patients (83.3%) have not experienced rebleeding; shunt failure led to rebleeding in only 1 patient (5.6%). SDPHG shunt placement can be performed with low morbidity and surgical mortality. Nontransplantation candidates with Child\u2019s class A and B cirrhosis have excellent long-term survival with this safe, effective, and definitive treatment for refractory variceal bleeding.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1053\/jlts.2000.6141","type":"journal-article","created":{"date-parts":[[2003,3,25]],"date-time":"2003-03-25T17:39:23Z","timestamp":1048613963000},"page":"459-465","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":12,"title":["Small-diameter portacaval h-graft shunt: A paradigm shift back to surgical shunting in the management of variceal bleeding in patients with preserved liver function"],"prefix":"10.1097","volume":"6","author":[{"given":"Donald J.","family":"Hillebrand","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kourosh","family":"Kojouri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean","family":"Cao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce A.","family":"Runyon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Okechukwu","family":"Ojogho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Waldo","family":"Concepcion","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"10.1053\/jlts.2000.6141-BIB1","first-page":"122","volume":"7","author":"Gines","year":"1987","journal-title":"Gastroenterology"},{"key":"10.1053\/jlts.2000.6141-BIB2","first-page":"294","volume":"16","author":"Vidal","year":"1903","journal-title":"16th Cong Franc Chir"},{"key":"10.1053\/jlts.2000.6141-BIB3","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1097\/00000658-196709000-00011","volume":"166","author":"Warren","year":"1967","journal-title":"Ann 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