Distal splenorenal shunt. Hemodynamic advantage over total shunt and influence on clinical status, hepatic function and hypersplenism.

Clinical status, hepatic function and hypersplenism were investigated in 20 patients who underwent distal splenorenal shunt between January 1970 and June 1978. The operative morality rate was 5 percent, and encephalopathy of varying degrees affected 30 percent of the patients. There was no recurrence of bleeding, and the 3 to 5 year actuarial survival rate was 78 percent. Hypersplenism was significantly ameliorated in 17 patients (p less than 0.01). Serum glutamic improved and pyruvic transaminase significantly improved postoperatively and bilirubin significantly worsened, whereas other tests of liver function remained unchanged. Our results confirm the efficacy of this procedure in controlling recurrence of bleeding from esophageal varices. Moreover, severe hypersplenism is not an absolute contraindication to the shunt, which is preferable to total shunts since hepatopetal flow is preserved, thus avoiding early hepatic decompensation as demonstrated by the substantial stabilization of the liver function tests in the short run.