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Distal splenorenal shunt

  • Definition
    • A distal splenorenal shunt is a type of surgery done to relieve extra pressure in the portal vein. The portal vein carries blood from your digestive organs to your liver.

  • Alternative Names
    • DSRS; Distal splenorenal shunt procedure; Renal - splenic venous shunt; Warren shunt; Cirrhosis - distal splenorenal; Liver failure - distal splenorenal

  • Description
    • During the procedure, the vein from your spleen is removed from the portal vein. The vein is then attached to the vein to your left kidney. This helps reduce blood flow through the portal vein.

  • Why the Procedure is Performed
    • The portal vein brings blood from the intestine, spleen, pancreas, and gallbladder to the liver. When blood flow is blocked, the pressure in this vein becomes too high. This is called portal hypertension. It often occurs due to liver damage caused by:

      • Alcohol abuse
      • Chronic viral hepatitis
      • Blood clots
      • Certain congenital disorders
      • Primary biliary cirrhosis

      When blood cannot flow normally through the portal vein, it takes another path. As a result, swollen blood vessels called varices form. They develop thin walls that can break and bleed.

      You may have this surgery if endoscopy or x-rays show that you have bleeding varices. Distal splenorenal shunt surgery reduces pressure on the varices and helps control bleeding.

  • Risks
    • Risks for any anesthesia are:

      Risks for any surgery are:

      • Bleeding
      • Heart attack or stroke
      • Infection

      Complications from this procedure include:

      • Buildup of fluid in the belly (ascites)
      • Repeat bleeding from the varices
      • Encephalopathy (loss of brain function because the liver is unable to remove toxins from the blood)
  • Before the Procedure
    • Before the surgery, you may have certain tests:

      • Angiogram
      • Blood tests
      • Endoscopy
      • Galactose liver function test

      Give your health care provider a list of all the medicines you take (prescription and over-the-counter), herbs, and supplements. Ask which ones you need to stop taking before the surgery, and which ones you should take the morning of the surgery.

      Your provider will explain the procedure and tell you when to stop eating and drinking before the surgery.

  • After the Procedure
    • Expect to stay 7 to 10 days in the hospital after surgery to recover.

      When you wake up after the surgery you will have:

      • A tube in your vein (IV) that will carry fluid and medicine into your bloodstream
      • A catheter in your bladder to drain urine
      • An NG tube (nasogastric) that goes through your nose into your stomach to remove gas and fluids
      • A pump with a button you can press when you need pain medicine

      As you are able to eat and drink, you will be given liquids and food.

      You may have an imaging test to see if the shunt is working.

      You will meet with a dietitian, and learn how to eat a low-fat, low-salt diet.

  • Outlook (Prognosis)
    • Distal splenorenal shunts control bleeding in most people with portal hypertension. The highest risk of bleeding again is in the first month after surgery.

  • References
    • Elwood DR, Pomposelli JJ, Pomfret EA, et al. Distal splenorenal shunt: preferred treatment for recurrent variceal hemorrhage in the patient with well-compensated cirrhosis. Arch Surg. 2006 Apr;141(4):385-8.

      J. Michael Henderson JM, Boyer TD, Kutner MH, et al. Distal splenorenal shunt versus transjugular intrahepatic portal systematic shunt for variceal bleeding: a randomized trial. Gastroenterology. 2006;130(6):1643-51.

      Sicklick JK, D'Angelica M, Fong Y. The liver. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 54.