Analysis of a Distal Splenorenal Shunt for Treatment of Variceal Bleeding

ABSTRACT

BACKGROUND: Portal hypertension is a pathologic phenomenon caused by increased pressure in the portal vein. It's clinical importance lies in the development of secondary complications, such as variceal bleeding, hypersplenism, ascites, and hepatic encephalopathy. Especially, bleeding from esophagogastric varices is the single most life-threatening complication of portal hypertension. Nevertherless, these days, non-invasive techniques, such as endoscopic sclerotherapy, endoscopic band ligation, and a transjugular intrahepatic portosystemic shunt (TIPS) are available for treatment of variceal bleeding. However, a surgical procedure like a distal splenorenal shunt (DSRS) is still indicated in selective patients when a non-invasive technique has failed. Thus we reviewed and analyzed our experi ence with a distal splenorenal shunt for treatment of variceal bleeding in portal hypertension. METHODS: We retrospectively analyzed the medical records of 22 cases who had undergone a distal splenorenal shunt from 1980 to 1988 for treatment of portal hypertension with it's secondary com plications according to the patients age, sex, cause of disease, presence of secondary complications of portal hypertension, preoperative treatment, improvement of symptoms, mortality, survival rate, etc. All cases were treated preoperatively with non-invasive technique such as endoscopic sclerotherapy, endoscopic band ligation, a TIPS. RESULTS: The patients' average age was 45.5 years old. The most common cause of cirrhosis was of a viral origin. The duration for the symptoms of portal hypertension was 3.6 years. All cases had a history of recurrent variceal bleeding, and one case had hepatic encephalopathy. Preoperatively endoscopic sclerotherapy was done in 19 cases, and endoscopic band ligation was done in 3 cases. Of these 22 cases, only one case required a TIPS for decompression of the portal vein. According to the Child-Pugh classification, 12 cases were in class A and 10 cases were in class B. The estimated blood loss during the operation was about 800 to 1,900 cc. After operation, no recurrent variceal bleeding was found. The one case with hepatic encephalopathy was also controlled. A liver transplantation was Performed in onepatient, 4 years after DSRS. The operative mortality was 0%, and the survival rate for 1-year was 95%; that for 5-years was 50%. CONCLUSIONS: A distal splenorenal shunt is still a good modality for treating of portal hypertension with it's secondary complications, especially with variceal bleeding, and it could also serve as an excellent long-term bridge to liver tranplantation.