Distal splenorenal shunt for portal hypertension.

A distal splenorenal shunt was performed electively in 25 patients with bleeding oesophageal varices. Early postoperative mortality was 16%. During the follow-up period (mean 41 months) three patients died, one of liver insufficiency and two of cardiac complications. Two patients of 17 survivors (12%) had endoscopically demonstrable varices. One of these patients had one upper gastrointestinal rebleeding period. The actual three year survival was 71%. Reverse portal blood flow was demonstrated postoperatively in eight of 17 patients (47%). In these cases the distal splenorenal shunt had in fact slowly turned to a total shunt. Even though in certain patients the original selectivity of the shunt is lost it gives a good long-term variceal decompression and certainly is a useful alternative in the treatment of selected good risk patients for bleeding oesophageal varices.