Assessment of a modified technique of distal splenorenal shunting.

Warren's distal splenorenal shunt has been effective in treatment of recurrent variceal hemorrhage. To simplify the operative procedure, two alterations in the technique were used in this study. The first was to approach the splenic and renal veins simultaneously through a single inframesocolonic retroperitoneal incision in the plane of the pancreatic fusion fossa. The second was abandonment of the portoazygos disconnection. Since 1974, twenty-nine patients have undergone this modified operation. The patients ranged in age from 21 to 76 years. Fourteen patients had alcoholic cirrhosis, 13 had nonalcoholic cirrhosis, and the etiology was unknown in two. There were 14 Child's class A patients, 12 class B, and three class C. Significant ascites was present at operation in seven patients. Hepatofugal flow was demonstrated angiographically in four patients. The follow-up period ranged from 6 months to 6 years; 19 patients were followed up for 1 year or longer. There were three early postoperative deaths (10.3%), and one patient died 2 months postoperatively. Recurrent variceal bleeding was seen early in one patient and late (2 months) in another. Only one of the surviving patients developed encephalopathy. Technical modification to simplify performance of the distal splenorenal shunt did not compromise the results of the operation. However, four of seven patients with ascites died either immediately or early after the procedure, and two of these four patients also had hepatofugal flow. Ascites and hepatofugal flow may adversely influence the results of the operation.