Proximal leinorenal shut: an effective treatment of bleeding esophageal varices

ABSTRACT

This is a prospective study of 23 patients of portal hypertension who were managed by proximal leinorenal shunt. Out of 23 patients, 14 patients were in Child's B, 6 patients were in Child's A and only 4 patients were categorized as Child's C. Only two patients had non cirrhotic portal hypertension and rest of them were post-infective cirrhotic, one being alcoholic. All cirrhotic patients were HBsAg positive and 3 were hepatitis C positive. Fourteen had associated hypersplenism. All patients were managed by proximal leinorenal shunts. Ten patients had emergency surgery and 13 had elective shunts. Mean operative time was five hours and average peroperative blood loss was 1500 ml. Average post- operative hospital stay was 18 days. Maximum follow-up of two years is available. Re-bleeding rate was 17.3%. Post shunt encephalopathy developed in 8.14% patients. One mortality was due to overwhelming sepsis, ten days after surgery and he was in Child's grade B. Remaining three deaths were among Child's grade C. We believe that proximal leinorenal shunt is a good alternative to distal splenorenal shunt. This shunt while preserving the liver perfusion affords adequate decompression