Ovid: Welcome to Ovid

Distal Splenorenal Shunt: Preferred Treatment for Recurrent Variceal Hemorrhage in the Patient With Well-Compensated Cirrhosis.
Elwood, David R. MD; Pomposelli, James J. MD, PhD; Pomfret, Elizabeth A. MD, PhD; Lewis, W. David MD; Jenkins, Roger L. MD
[Article] Archives of Surgery. 141(4):385-388, April 2006.

(Format: HTML, PDF)

Hypothesis: Distal splenorenal shunt (DSRS) is a safe and effective treatment for patients with Child-Pugh class A and B cirrhosis with recurrent variceal hemorrhage after failed transjugular intrahepatic portosystemic shunt.

Design: Retrospective case review.

Setting: Hepatobiliary surgery and liver transplantation department in a tertiary referral medical center.

Patients: Between August 1, 1985, and May 1, 2005, 119 patients with Child-Pugh class A and B cirrhosis underwent DSRS for recurrent variceal hemorrhage. Of these, 17 (14.3%) had thrombosed or failing transjugular intrahepatic portosystemic shunt prior to DSRS.

Intervention: Distal splenorenal shunt for recurrent variceal hemorrhage after failure of conservative management.

Main Outcome Measures: Morbidity, mortality, and subsequent liver transplantation rate.

Results: The overall perioperative morbidity rate was 31.5%. Thirteen patients (11.7%) developed encephalopathy and 6 (5.4%) had recurrent variceal hemorrhage. Other complications included portal vein thrombosis, pancreatitis, pancreatic pseudocyst, pneumonia, and wound infection. The 30-day operative mortality rate was 6.4% (n = 7). The 1-year survival rate was 85.9%. The incidence of DSRS for failed transjugular intrahepatic portosystemic shunt during the first 12 years of the study (1985-1997) was 11.1% (9/81). This proportion increased to 26.7% (8/30) during the second half of the study (1997-2005). During the 20-year period, 15 patients (13.5%) underwent liver transplantation a mean of 5.1 years after DSRS without an increase in morbidity or mortality after transplantation.

Conclusions: Distal splenorenal shunt may be the preferred treatment for recurrent variceal hemorrhage in the patient with well-compensated cirrhosis. In addition, DSRS does not cause increased morbidity or mortality in subsequent liver transplantation.