Suppression of the shunt and esophageal transection. A new technique for the treatment of disabling postshunt encephalopathy.

A new surgical procedure was developed for the treatment of disabling postshunt encephalopathy. This procedure consists of an esophageal transection with esophagogastric devascularization, followed by suppression of the shunt. Suppression of the shunt is performed postoperatively using external maneuvers. In the four patients treated, suppression of the shunt led to disappearance of the clinical manifestations of encephalopathy in three and to a significant improvement in one. Providing that the shunt is side-to-side, this new treatment would allow a dramatic improvement in the small number of patients in whom severe encephalopathy develops after portosystemic shunting.