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Portosystemic Shunts: ameroid, vs. cellophane band vs. suture vs. coils?
Tivers M.
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Introduction:
A variety of surgical techniques are recommended for the treatment of congenital portosystemic shunts (CPSS) in dogs including the use of ameroid constrictors, cellophane bands, suture ligation and intravascular coils1-9. Whilst the potential advantages and disadvantages of these techniques are well recognised it remains unclear which technique provides the best outcome.
Outcome Assessment:
There are a wide variety of published studies reporting the short and long-term outcome for different treatment options in dogs with extrahepatic and intrahepatic CPSS. Reported outcome measures include clinical assessment, owner assessment, serum bile acid or ammonia tolerance testing, scintigraphy and computed tomography. However, it is unclear which of these represents the most appropriate or reliable assessment. Comparisons between different treatments are hampered by this wide variation in outcome assessment between studies.
Assessment of the evidence for treatment of CPSS:
The strength of any study that compares two treatments is dependent on whether patients were randomly allocated to treatment groups, whether the assessors were blinded, whether the treatment groups were similar, whether the follow up was sufficient and whether groups were managed equally apart from the treatment. Therefore, when attempting to choose between treatments for CPSS ideally the decision would be based on evidence from prospective randomized controlled trials, comparing two or more techniques. [...]
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