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Surgical Shunt Procedure

The Portal Shunt or Portal Systemic Shunt was fist performed in 1945 as the first definitive form of therapy for patients with bleeding esophageal varices from portal vein hypertension. The purpose of this procedure is to reduce the pressure in the portal vein that carries blood to the liver by surgically joining the portal vein to the inferior vena cava. This stops bleeding from esophageal varices and can also reduce swelling (ascites) in the abdomen. Patients with preserved liver function (ChildsA) are good candidates for elective portal systemic shunt surgery. This procedure is performed only on a relatively small number of patients that bleed from esophageal varices or have poorly controlled ascites. Persistent confusion, forgetfulness (encephalopathy) and liver failure are well-described complications of this procedure.

The Distal Splenorenal Shunt (DSRS) procedure decompresses varices in the esophagus and stomach by joining the splenic vein as it leaves the spleen to the vein draining the left kidney. This preserves the flow of blood through the portal vein to the liver. Patients with non-alcoholic cirrhosis respond better to DSRS than those with alcoholic cirrhosis. Although DSRS has a lesser rate of encephalopathy and liver failure, it is a technically more demanding procedure and has a higher rate of operative complications, including death, when compared to the portal systemic shunt. In experienced hands, the DSRS is the shunt most indicated in the non-emergent elective setting for patients with good liver function.

The initial management of patients with bleeding esophageal varices is most often with endoscopic banding. This procedure in combination with a pill to reduce the pressure in varices can prevent further bleeding. Another way to treat varices is with sclerotherapy. This is performed by injecting an irritant into varices, causing the veins to scar and contract. Patients that suffer from recurrent bleeding, an indication that banding or sclerotherapy are failing, are then treated surgically. Combining these two treatments may significantly increase the survival rate of these patients.

The Transjugular Intrahepatic Portal Systemic Shunt (TIPSS) is the ideal procedure in situations where bleeding is recurrent and cannot be controlled by banding or sclerotherapy. One of the advantages of TIPSS is that it is minimally invasive, performed with local anesthesia and sedation by an interventional radiologist. This eliminates the risks of general anesthesia and major surgery. Another important advantage is that TIPSS reduces the accumulation of fluids in the abdomen (ascites). Although this type of shunt often blocks and narrows it is often used for patients awaiting liver transplant. Approximately ¼ of patients treated with this procedure develop encephalopathy.

© Copyright January 2002 - Latino Organization for Liver Awareness

Revised on March 2009 by: Dr. Andrew De La Torre, Associate Professor of Medicine, Newark University Hospital