# Cellophane Banding Without Intraoperative Attenuation of Congenital Gastrophrenic Shunts in 12 Cases

## TL;DR

A study found that cellophane banding without intraoperative attenuation can safely and effectively close congenital left gastrophrenic shunts in most treated animals.

## Contribution

This case series presents a novel application of cellophane banding without initial attenuation for congenital left gastrophrenic shunts in veterinary patients.

## Key findings

- Complete shunt closure was observed in 10 out of 11 patients at a median follow-up of 60 days.
- Cellophane banding without intraoperative attenuation showed a higher closure rate than previously reported techniques for similar shunts.

## Abstract

Several techniques for gradual vascular occlusion have been described for the treatment of a congenital extrahepatic CPS, including cellophane banding. Residual shunting has been reported to be more common with cellophane banding than with other techniques, being 35% when no initial attenuation of the shunt was performed. This case series evaluated the outcomes and complications of 12 patients with a congenital left gastrophrenic shunt who were treated with cellophane banding without intraoperative attenuation. Complete closure of the shunt was observed on ultrasound in 10/11 patients at a median follow-up of 60 days. The clinical outcomes were excellent. This cases series suggests that cellophane banding without intraoperative attenuation may be a safe and effective technique for gastrophrenic shunts.

Reports on patients with a gastrophrenic shunt treated with cellophane banding without attenuation are scarce. This case series evaluated the outcomes of cellophane banding without intraoperative attenuation in patients with a congenital left gastrophrenic shunt. Seven client-owned dogs and five client-owned cats with congenital left gastrophrenic shunt were included. Data collected from the medical records included signalment, history, physical examination, clinicopathologic testing, diagnostic imaging (pre and postoperative), perioperative complications, hepatic histopathological evaluation, and clinical outcomes. The application of a cellophane band without intraoperative attenuation of congenital left gastrophrenic shunts resulted in complete closure in 10/11 patients at a median follow-up of 60 days (range: 33–174) based on ultrasound. The mean shunt diameter was 6.1 mm (range: 4.2–8). One dog had partial closure of the shunt at 3 months but was lost to follow-up. One dog died perioperatively from seizures. One cat experienced post-attenuation neurologic signs that completely resolved. Cellophane banding without intraoperative attenuation appeared to be a safe and potentially effective approach for managing gastrophrenic shunts. The percentage of shunt closure observed in this cases series is higher than that historically reported for other shunt localizations. Shunt localization may influence closure. Residual shunting may not be associated with shunt diameter. Further studies with larger sample sizes and standardized follow-ups are needed to confirm its efficacy.