Distal splenorenal shunt procedure explained

Distal splenorenal shunt procedure
Synonyms:Splenorenal shunt procedure

In medicine, a distal splenorenal shunt procedure (DSRS), also splenorenal shunt procedure and Warren shunt,[1] is a surgical procedure in which the distal splenic vein (a part of the portal venous system) is attached to the left renal vein (a part of the systemic venous system). It is used to treat portal hypertension and its main complication (esophageal varices).[2] It was developed by W. Dean Warren.

Splenopancreatic and gastric disconnection (SPGD)

DSRS is typically done with splenopancreatic and gastric disconnection (ligation of the gastric veins and pancreatic veins (that drain into the portal vein) and complete detachment of the splenic vein from the portal venous system), as it improves the outcome.[3]

Comparison to TIPS

Survival with a transjugular intrahepatic portosystemic shunt (TIPS) versus a DSRS is thought to be approximately similar,[4] [5] but still an area of intensive research.[6] [7]

Both TIPS and DSRS lead to decreased rates of variceal bleeding at the expense of hepatic encephalopathy; however, TIPS appears to have more shunt dysfunction and lead to more encephalopathy and bleeds.[5] DSRS appears to be more cost effective than TIPS.[8]

External links

Notes and References

  1. Warren WD, Henderson JM, Millikan WJ, Galambos JT, Brooks WS, Riepe SP, Salam AA, Kutner MH . Distal splenorenal shunt versus endoscopic sclerotherapy for long-term management of variceal bleeding. Preliminary report of a prospective, randomized trial . Ann. Surg. . 203 . 5 . 454–62 . May 1986 . 3486641 . 1251141 . 10.1097/00000658-198605000-00002 .
  2. Boyer TD, Kokenes DD, Hertzler G, Kutner MH, Henderson JM . Effect of distal splenorenal shunt on survival of patients with primary biliary cirrhosis . Hepatology . 20 . 6 . 1482–6 . December 1994 . 7982648 . 10.1002/hep.1840200617 . free .
  3. Hirano S, Kondo S, Ambo Y, Tanaka E, Morikawa T, Okushiba S, Katoh H . Appraisal of DSRS with SPGD for esophagogastric varices: a retrospective comparative study according to the underlying liver diseases . Hepatogastroenterology . 52 . 61 . 152–5 . 2005 . 15783017 .
  4. Web site: Update on the Role of TIPS in the Management of Portal Hypertension . Rockey . DC. Medscape . WebMD LLC . March 18, 2006. registration .
  5. Khan S, Tudur Smith C, Williamson P, Sutton R . Portosystemic shunts versus endoscopic therapy for variceal rebleeding in patients with cirrhosis . Cochrane Database Syst Rev . 4 . CD000553 . October 2006 . 17054131 . 10.1002/14651858.CD000553.pub2 . 7045742 .
  6. Web site: Multicenter, Randomized Trial of DSRS vs. TIPS . University of Wisconsin- Madison, General Surgery . 2006-03-18 . 2007-02-08 . https://web.archive.org/web/20070208155418/http://www.surgery.wisc.edu/general/research/grants_rikkers_nih.shtml . dead .
  7. Henderson JM, Boyer TD, Kutner MH, Galloway JR, Rikkers LF, Jeffers LJ, Abu-Elmagd K, Connor J . Distal splenorenal shunt versus transjugular intrahepatic portal systematic shunt for variceal bleeding: a randomized trial . Gastroenterology . 130 . 6 . 1643–51 . May 2006 . 16697728 . 10.1053/j.gastro.2006.02.008 .
  8. Zacks SL, Sandler RS, Biddle AK, Mauro MA, Brown RS . Decision-analysis of transjugular intrahepatic portosystemic shunt versus distal splenorenal shunt for portal hypertension . Hepatology . 29 . 5 . 1399–405 . May 1999 . 10216122 . 10.1002/hep.510290512 . free .

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