Selective distal splenorenal shunt without requiring splenopancreatic disconnection with the use of the external iliac vein graft: A preliminary report

Kato, Kentaro; Kondo, Satoshi; Morikawa, Toshiaki; Okushiba, Shunichi; Katoh, Hiroyuki

doi:10.1016/s0039-6060(99)70101-7

Cited by 7 publications

(5 citation statements)

References 6 publications

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“…In the present study, the mortality in patients who had the combined procedure (2.2%, 2/90) was similar to that in the PCDV group (6.4%, 5/78). These figures are comparable to the 0–12% mortality reported in the literature for devascularization procedures [4, 14, ] and various shunts in cirrhotic patients.…”

Section: Resultssupporting

confidence: 86%

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Effects of modified splenocaval shunt plus devascularization on esophagogastric variceal bleeding: a comparative study of this treatment and devascularization only in cirrhotic portal hypertension

Wang

Zhang

et al. 2010

J Hepato Biliary Pancreat

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Section: Resultssupporting

confidence: 86%

“…In our present study, the overall incidence of residual (5.1%) and recurrent (3.8%) varices in the combined group was lower than those in the PCDV group (13.3 and 15.0%). The figures are comparable to those for the incidences of 5–6% [4, 14, ] reported in devascularization procedures and 1.9–15.0% reported in shunts in cirrhotic patients.…”

Section: Resultssupporting

confidence: 85%

Effects of modified splenocaval shunt plus devascularization on esophagogastric variceal bleeding: a comparative study of this treatment and devascularization only in cirrhotic portal hypertension

Wang

Zhang

et al. 2010

J Hepato Biliary Pancreat

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“…They later devised the selective DSRS, which separates the pancreatic venous flow and the splenic venous flow. Katoh et al [9] reported in 1984 that it is possible to prevent portal runoff and to maintain effective portal blood flow long-term by blocking the blood flow in the periphery of the stomach, thus reducing venous pressure selectively in the lower part of the esophagus and the upper part of the stomach. DSRS is also performed by our institution for portal hypertension following hepatitis and alcoholic cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

“…Although definitive in terms of obtaining hemostasis, DSRS for controlling esophagogastric varices is not widely performed because it is technically difficult. Kato et al [11] uses an external iliac vein graft to simplify the procedure, which may make this method more accessible to other surgeons.…”

Section: Discussionmentioning

confidence: 99%

Long‐term Efficacy of Distal Splenorenal Shunt with Splenopancreatic and Gastric Disconnection for Esophagogastric Varices in Patients with Idiopathic Portal Hypertension

et al. 2005

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Idiopathic portal hypertension (IPH) requires invasive measures to prevent rupture and bleeding of esophagogastric varices. However, the long-term results of shunt surgery for IPH have not been reported. In particular, the pros and cons of surgery that preserves the spleen and its long-term hematologic effects have not been described. The records of 15 patients who underwent distal splenorenal shunt with splenopancreatic and gastric disconnection (DSRS with SPGD) for IPH between 1983 and 1998 was reviewed retrospectively. One patient died within 3 years of surgery, for a 3-year survival rate of 93%; the 10-year survival rate was 64%. Three patients (18%) suffered rebleeding from esophagogastric varices. The white blood cell and platelet counts were higher 3-5 years and 7-13 years postoperatively compared with preoperative values. Four of five patients who underwent postoperative computed tomography had a smaller spleen postoperatively. DSRS with SPGD provides long-term hemostasis for esophagogastric variceal bleeding in IPH and alleviates hypersplenism. DSRS with SPGD is an effective treatment for patients with IPH in whom long-term survival is expected.

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“…DSRS with external iliac vein graft without spleno-pancreatic disconnection was done with minimal splenopancreatic dissection and with relatively easier technique. It was found more suitable in maintain the hepatopedal prograde portal flow and in turn maintaining the selectivity of the shunt [22]. This selectivity was even long lasting when gastric disconnection was added, further reducing diversion of portal flow from gastric wall [23].…”

Section: Modified Dsrsmentioning

confidence: 99%

Pancreatic Siphon: A Major Determinant of Selective Shunts. Is it a Historical Entity now?

Narkhede¹

2016

J Surg Surgical Res

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Surgical management of portal hypertension has changed according to time, evolving from just complete shunts to selective shunts and to liver transplantation. The outcomes also greatly improved owing to better understanding of portal hemodynamics and disease nature. Introduction of selective shunts showed promising results just to be challenged by poor outcome with development of "pancreatic siphon" which then studies in detail. This intra-pancreatic and peri-pancreatic collateral veins which connected portal and splenic veins formed basis of systemic loss of portal flow and thus ending up in failure of selectivity. Pancreatic siphon was found to be associated with increased rates of hepatic encephalopathy post selective shunting along with increased rates of hepatic failure. In addition to this pancreatic siphon led to metabolic sequel like new onset of diabetes, ischemic or compressive pancreatic ductopathy and intrapancreaic cholangiopathy. Although the shunting procedures are not that commonly done, pancreatic siphon has moved out of the limelight. It was just an attempt of recapping the existence of an unfamiliar entity forming delicate balance in the portal circulation. radicals connecting portal and splenic circulations [3]. Furthermore in response to pathology like portal venous thrombosis and splenic venous thrombosis these collaterlas tend to dilate and decompress respective compartments [3]. So development of pancreatic siphon is natural response of persistent elevated pressure in the mesentericoportal circulation over the intra-pancreatic and peri-pancreatic venous channels after splenic venous division and DSRS. Even such intra-pancreatic collaterals are seen in portal venous thrombosis with or without liver cirrhosis, without any clinically significant mass effect [4]. Ligation of coronary vein is a crucial step in creation of DSRS, failure of which can hasten the collateralisation and early formation of pancreatic siphon effect [5]. This intra-pancreatic collateral network along with coronary vein helps in decompressing gastrospenic compartment in inferior mesenteric-renal shunt which is a rare type of selective shunt [2]. The alcoholic patients, cirrhotics and post hepatitis patients were found to be specially prone for the development of pancreatic siphon [6], following selective shunts and porto-splenic thrombosis.

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Selective distal splenorenal shunt without requiring splenopancreatic disconnection with the use of the external iliac vein graft: A preliminary report

Cited by 7 publications

References 6 publications

Effects of modified splenocaval shunt plus devascularization on esophagogastric variceal bleeding: a comparative study of this treatment and devascularization only in cirrhotic portal hypertension

Effects of modified splenocaval shunt plus devascularization on esophagogastric variceal bleeding: a comparative study of this treatment and devascularization only in cirrhotic portal hypertension

Long‐term Efficacy of Distal Splenorenal Shunt with Splenopancreatic and Gastric Disconnection for Esophagogastric Varices in Patients with Idiopathic Portal Hypertension

Pancreatic Siphon: A Major Determinant of Selective Shunts. Is it a Historical Entity now?

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