Outcomes after extrahepatic portosystemic shunt ligation in 49 dogs

Geraldine B Hunt, J. Hughes

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Objective To evaluate outcomes after attenuation of extrahepatic portosystemic shunts in dogs using surgical silk. Design Retrospective study. Procedure Case records were reviewed for degree of surgical attenuation, experience of the primary surgeon, perioperative mortality and problems related to persistent portosystemic shunting or shunt ligation. Presence of portosystemic shunting after surgery was evaluated by ammonia tolerance testing, measurement of postprandial serum bile acid, plasma urea and cholesterol concentrations and liver enzyme activity. The influence of age, postocclusion portal pressure, primary surgeon, degree of attenuation and postoperative biochemical findings on the occurrence of postoperative problems was assessed. Results The mortality rate was 2.1%. Shunt attenuation was complete in 34% and partial in 66% of dogs. Portal hypertension necessitating ligature removal was encountered in only one dog. Five dogs experienced neurological abnormalities (seizures or ataxia), possibly as a manifestation of 'postligation seizure syndrome'. Postoperative liver function was normal in 78% of dogs, including 70% with partial shunt attenuation. Experience of the surgeon was related positively to outcome after partial attenuation (P = 0.002). Postoperative biochemical evidence of abnormal liver function was the most sensitive predictor of recurrence of clinical signs referable to persistent portosystemic shunting. Conclusions In the hands of an experienced surgeon, surgical attenuation of single extrahepatic shunts was safe and effective, even in animals with partial attenuation. Most dogs with biochemical evidence of persistent shunting suffer relapse of clinical signs within 18 months of surgery. Postligation neurological syndromes of variable intensity may be more common than previously thought.

Original languageEnglish (US)
Pages (from-to)303-307
Number of pages5
JournalAustralian Veterinary Journal
Volume77
Issue number5
StatePublished - May 1999
Externally publishedYes

Fingerprint

Surgical Portasystemic Shunt
Ligation
surgeons
Dogs
dogs
liver function
seizures
Liver
Seizures
surgery
portal hypertension
Portal Pressure
Recurrence
Silk
Mortality
relapse
Portal Hypertension
bile acids
Ataxia
silk

Keywords

  • Dog
  • Extrahepatic portosystemic shunt
  • Surgery
  • Surgical outcomes

ASJC Scopus subject areas

  • veterinary(all)

Cite this

Outcomes after extrahepatic portosystemic shunt ligation in 49 dogs. / Hunt, Geraldine B; Hughes, J.

In: Australian Veterinary Journal, Vol. 77, No. 5, 05.1999, p. 303-307.

Research output: Contribution to journalArticle

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abstract = "Objective To evaluate outcomes after attenuation of extrahepatic portosystemic shunts in dogs using surgical silk. Design Retrospective study. Procedure Case records were reviewed for degree of surgical attenuation, experience of the primary surgeon, perioperative mortality and problems related to persistent portosystemic shunting or shunt ligation. Presence of portosystemic shunting after surgery was evaluated by ammonia tolerance testing, measurement of postprandial serum bile acid, plasma urea and cholesterol concentrations and liver enzyme activity. The influence of age, postocclusion portal pressure, primary surgeon, degree of attenuation and postoperative biochemical findings on the occurrence of postoperative problems was assessed. Results The mortality rate was 2.1{\%}. Shunt attenuation was complete in 34{\%} and partial in 66{\%} of dogs. Portal hypertension necessitating ligature removal was encountered in only one dog. Five dogs experienced neurological abnormalities (seizures or ataxia), possibly as a manifestation of 'postligation seizure syndrome'. Postoperative liver function was normal in 78{\%} of dogs, including 70{\%} with partial shunt attenuation. Experience of the surgeon was related positively to outcome after partial attenuation (P = 0.002). Postoperative biochemical evidence of abnormal liver function was the most sensitive predictor of recurrence of clinical signs referable to persistent portosystemic shunting. Conclusions In the hands of an experienced surgeon, surgical attenuation of single extrahepatic shunts was safe and effective, even in animals with partial attenuation. Most dogs with biochemical evidence of persistent shunting suffer relapse of clinical signs within 18 months of surgery. Postligation neurological syndromes of variable intensity may be more common than previously thought.",
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