Ann Surg 1991 Nov;214(5):581-9

Portasystemic shunting versus liver transplantation for the Budd-Chiari syndrome

Bismuth H, Sherlock DJ

Hepato-Biliary Surgery and Liver Transplant Unit, South Paris Faculty of
Medicine, Paul Brousse Hospital, Villejuif, France.

Abstract
Over 12 years, 22 patients with the Budd-Chiari syndrome were treated
surgically. Eighteen underwent a mesenterico-caval shunt (MCS); two, a
side-to-side portacaval shunt; one, a mesenterico-atrial shunt (MAS); and one, a
liver transplantation (OLT). One patient died after operation from the
precipitating condition, and two MCS grafts that thrombosed were restored. All
21 surviving patients remain well, free from ascites, and all shunts are patent
after a mean follow-up of 5.6 +/- 1 years, five patients with more than 10
years' follow-up. This long-term survival achieved by portasystemic shunts
suggests that they have a major role in the treatment of the Budd-Chiari
syndrome. The authors prefer the mesenterico-caval shunt using a jugular graft.
This ensures a total portasystemic shunt, avoids subhepatic surgery, and reduces
the long-term risk of prosthetic graft thrombosis. The MAS was reserved for
cases with complete caval thrombosis. Patients with significant degrees of caval
compression were satisfactorily decompressed by MCS. In patients not promptly
treated, the disease progresses to cirrhosis, and such patients must be
evaluated for transplantation similarly to those with other hepatopathies.