Distal Splenorenal Shunt Procedure

What is the distal splenorenal shunt procedure?

The distal splenorenal shunt is a surgical procedure. During the surgery, the vein from the spleen (called the splenic vein) is detached from the portal vein and reattached to the left kidney (renal) vein. This surgery selectively reduces the pressure in your varices (the large, swollen veins that develop across the stomach and esophagus) and controls the bleeding and clotting.

Why do I need to have the distal splenorenal shunt procedure?

X-rays and blood tests confirm that you have variceal bleeding due to portal hypertension. Portal hypertension is a condition characterized by increased pressure in the portal vein (the vein that carries blood from the digestive organs to the liver). Your physician has chosen the distal splenorenal shunt procedure to treat this condition. This procedure helps control the bleeding in the varices, without taking the blood flow away from your liver and making your liver disease worse.

What tests are required before the procedure?

Before the procedure, you will have had the following tests to determine the extent and severity of your portal hypertension condition:

Before the procedure, your physician may ask you to undergo pre-operative tests. The tests can include an electrocardiogram (also called an EKG), chest x-ray or additional blood tests. If your physician thinks you will need additional blood products (such as plasma), they will be ordered at this time.

Before the surgery

You will meet with the nurse clinician and your physician to discuss the steps of the surgery and any questions you may have. Before the surgery, please follow these guidelines:

Eating and drinking

Medications

Note: Do not discontinue any medications without first consulting with your physician.

On the day of the surgery

Please do not bring valuables such as jewelry or credit cards.

A general anesthetic will be given to you before the surgery. The time required to perform the surgery is about 4 hours.

You will be required to stay in the hospital from 7 to 10 days after the surgery. Please bring a robe and any other items you would like to make your stay more comfortable.

After the surgery

* Note: the therapies and time intervals listed above are typical and may change depending on the expertise of your healthcare provider and your condition.

What are the potential complications of this surgery?

Follow-up medical care

What do I need to do to maintain my health after the surgery?

Fig 1: Portal hypertension before the distal splenorenal shunt surgery is performed.

Varices develop across the esophagus and stomach from the pressure in the portal vein. The backup of pressure also causes the spleen to become enlarged.

Fig 2: After the distal splenorenal shunt surgery is performed.

The vein from the spleen is disconnected from the portal vein and reconnected to the top of the left renal vein. The left gastric vein is disconnected from the portal vein and tied off.

The blood flows from the varices through the splenic vein, to the left renal vein and empties into the inferior vena cava. The blood flow to the liver is maintained through the portal vein.

References

 

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the Center for Consumer Health Information at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. If you prefer, you may visit www.clevelandclinic.org/health/ or www.clevelandclinicflorida.org. This document was last reviewed on: 12/15/2013

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