Efficacy and risks of the distal splenorenal shunt in the treatment of bleeding esophageal varices.

Analysis of twenty-two patients who underwent distal splenorenal anastomosis shows that the operative mortality and morbidity are low if the indications for the procedure are strictly adhered to. The decompression of the esophageal varicosities is effective, even in the presence of persistent varicosities. This decompression is probably less important and perhaps slower than after portacaval shunting, so we now do not recommend distal splenorenal shunting as an emergency operation. Thrombosis of the shunt is rare and related especially to local anatomic conditions and operative technic. Shunt thrombosis is an early complication that we observed on two occasions manifested by recurrence of hemorrhage. There does not appear to be an appreciable difference between the terminoterminal and terminolateral distal splenorenal anastomoses. The effect of ligation of the splenic artery in the hypersplenism is doubtful. The frequency of postanastomotic encephalopathy is minimal with this type of shunt. Liver function tests were little changed during the period of postoperative observation, but our results do not permit us to conclude that the distal spleno-renal anastomosis less unfavorably affects liver function than do classic shunts.