SELECTIVE TRANS-SPLENIC DECOMPRESSION OF GASTROESOPHAGEAL VARICES BY DISTAL SPLENORENAL SHUNT

A new operative procedure was described in which selective shunting was accomplished through an in situ spleen and a distal splenorenal shunt. The rationale of the procedure was to decompress the area critical for control of hemorrhage while maintaining a high pressure intestinal venous system and preserving portal flow to the liver. Successful accomplishment of this goal was demonstrated radiographically with diversion of splenic flow through a distal splenorenal shunt while superior mesenteric flow continues to perfuse the liver. The proposed metabolic advantage was confirmed by a markedly superior response to protein tolerance testing. From these preliminary studies, use of this type of procedure seems indicated in patients with high volume portal flow to the liver. Typical examples are seen in early cirrhosis with marked splenomegaly and in so-called idiopathic portal hypertension.