Bilateral gastric venous decompression by a modified Warren shunt.

A new modification of the Warren shunt by which the coronary and short gastric venous systems can be simultaneously decompressed was carried out on two patients with oesophagogastric varices due to liver cirrhosis. One was an elective and the other an emergency operation. The left gastric vein entering the splenic vein was also drained through a Gore-Tex graft between the splenic and left renal veins. The proximal end of the splenic vein was ligated at its junction to the superior mesenteric vein. Porta-azygos disconnection was achieved by ligating the right gastric and gastro-epiploic veins. The shunt was patent and its effect on the varices was immediate with good decompression in both patients. The patients have had no recurrent variceal haemorrhage or postshunt encephalopathy. This modification may be indicated for selected patients with portal hypertension for both elective and emergency operations.