Retroperitoneal approach for portasystemic decompression.

A left retroperitoneal approach has been developed and used to perform a renal-splenic shunt for portal decompression in seven patients with massive variceal hemorrhage. In each patient, at least one intra-abdominal finding contraindicated a conventional transperitoneal portasystemic shunt. Retroperitoneal approach avoided possible complications and permitted successful portal decompression with cessation of bleeding in each instance. These results support the use of this technique when it is necessary to avoid the peritoneal cavity in a patient requiring portasystemic decompression.