Distal splenorenal shunt: standard procedure for elective and emergency treatment of bleeding esophageal varices.
The distal splenorenal shunt has been advocated for patients with bleeding esophageal varices because it is a selective shunt which decompresses the varices while preserving hepatic flow. The procedure appeared sound physiologically and since 1976, the distal splenorenal shunt has been our procedure of choice for both emergency and elective situations. Our series of 43 patients included 6 patients in Child's class A, 18 in Child's class B, and 19 in Child's class C. The operative mortality rate was 4.7 percent (2 of 43 patients) and there were 34 long-term survivors (79 percent). Use of modern cardiovascular techniques is an essential facet of the surgeon's technical ability to achieve low morbidity and mortality rates. In the present series, the average blood loss was 440 ml and the average operative time, 2 1/2 hours. The distal splenorenal shunt can be performed for emergency and elective therapy of bleeding esophageal varices with a low incidence of complications and death and excellent long-term quality of life.