Coronary-renal shunt combined with splenectomy for selective variceal decompression

Abstract

Instruction: Selective shuns for gastroesophageal varices including distal splenorenal shunt and coronary-caval shunt may not solve the problems of the giant spleen with serious hypersplenism or deep location of the left gastric vein behind the pancreas. A new selective shunt procedure should be explored. Methods: Coronary-renal shunt combined with splenectomy was performed on 16 patients with gastroesophageal varices and serious hypersplenism due to posthepatitic cirrhosis. The patients had the dilated left gastric vein entering the splenic vein by preoperative CT angiorgraphic evaluation. After splenectomy, the proximal part of the splenic vein with a length of 3-5cm and the left gastric vein were freed from the pancreas. The freed splenic vein was divided at the distal side with the proximal orifice anasomosed to the left renal vein. Ligation or division between sutures was applied to the splenic vein between portal vein and left gastric vein. The right gastric and gastro-epiploic vessiles were divided to occlude the back flow from the portal vein. Results: There were no operative motality and no procedure-relative complications. Post-operative CT and endoscopy showed the shunts were patent with reduced or obliterative varices in all sixteen patients. There were no recurrent variceal haemorrhage nor encephalopathy by 6-36 months' follow-up. Conclusion: This procedure can reach the aim of selective variceal decompression when splenectomy is required. Keywords: portal hypertension; coronary-renal shunt; selective variceal decompression; splenectomy