Does surgical or medical management of extrahepatic portosystemic shunts in dogs carry a better prognosis for the resolution and reduction of neurological dysfunction?

TL;DR

This study compares the effectiveness of surgery versus medication in managing portosystemic shunts in dogs, focusing on neurological outcomes.

Contribution

It provides a critical review of existing literature to assess the short-term and long-term neurological outcomes of two treatment approaches.

Findings

Both surgical and medical management reduced neurological signs in the short term.

Surgical management was weakly associated with higher mortality or severe neurological signs post-surgery.

There is insufficient evidence to determine which treatment is more effective long-term.

Abstract

PICO question

In dogs with congenital extrahepatic portosystemic shunts that are treated with surgical attenuation what is the persistency, frequency, severity and outcome of neurological signs when compared to dogs that are treated medically?

Clinical bottom line

Category of research question

Prognosis

The number and type of study designs reviewed

Ten papers were critically reviewed

Strength of evidence

Weak

Outcomes reported

For short-term success, owners reported an overall decrease in neurological signs associated with neurological dysfunction and an increase in quality of life after the initiation of either medical management or surgical management. Surgical management has a weak association with higher mortality or severe neurological signs in the immediate postoperative period

Conclusion

It is challenging to make a direct comparison between medical and surgical management but, overall, both strategies seemed to decrease neurological signs in the short term. There was a lack of evidence and available data about the efficacy of each for long-term control of neurological signs