Selective distal splenorenal shunt for bleeding esophageal varices.

The selective distal splenorenal shunt has been shown to be equally as effective as total portal-systemic shunting procedures in the control of variceal hemorrhage and it can now be performed with an equivalent operative mortality. It is superior to other shunts in metabolic aspects and results in a markedly decreased incidence of postoperative hepatic encephalopathy. Massive ascites constitutes a definite contraindication to the selective distal splenorenal anastomosis, but for all other suitable patients this procedure appears to be the optimal method of surgical management at this time.