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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.

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:

  • Evaluation of your medical history
  • A physical examination
  • Blood tests
  • Angiogram
  • Endoscopy

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

  • DO NOT eat or drink anything after midnight the day of the surgery.

Medications

  • Discontinue taking beta-blocker medications (such as Inderal) 48 hours prior to the surgery.
  • Ask your physician if you should take your other daily medications before the surgery.

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

  • A temporary catheter will be placed in your bladder for 24 to 48 hours after the surgery to drain urine.
  • A nasogastric tube will be placed through your nose and into your stomach for 24 hours after the surgery. This tube will remove gas or gastric secretions directly from the stomach. Once your digestive system starts working again, your diet will gradually advance and you will be able to eat solid foods.
  • An IV will be inserted in your neck to deliver fluids and medication.
  • Your pain will be managed by a patient-controlled pain pump. This will deliver narcotics directly into your IV on demand (when you decide you need them).
  • Within 7 days after the surgery, you will have an angiogram to determine the effectiveness of the shunt. If the shunt appears to be functioning properly, you will be discharged the following day.
  • A dietitian will explain your nutrition requirements before you go home. You will be asked to follow a low-fat, low-salt diet. You will probably be required to consume no more than 2 grams of sodium (salt) or 30 grams of fat per day for 6 to 8 weeks after the procedure. The dietitian will explain how to figure these amounts in your diet.

What are the potential complications of this surgery?

  • Ascites -- an accumulation of fluid in the abdomen. This condition can be treated with medications called diuretics and restricted sodium intake.

Follow-up medical care

  • Ten days after your hospital discharge date, you will meet with the surgeon to evaluate your progress. Lab work will be done at this time. You will meet again with your surgeon one month after the date of your surgery and then again in three months for additional lab work.
  • You will meet with the surgeon and nurse clinician six months after the date of your surgery and then annually for the following:
    -- Lab work
    -- Ultrasound of the shunt

More frequent follow-up visits may be necessary, depending on your condition.

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

  • Be sure to follow the dietary recommendations provided by your dietitian.
  • Progressively increase your activity level.
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.

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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 written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health/.

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