Distal splenorenal shunt

Definition

A distal splenorenal shunt (DSRS) is a type of surgery done to relieve high pressure in the portal vein. The portal vein carries blood from your digestive organs to your liver.

Alternative Names

DSRS; Distal splenorenal shunt procedure; Renal - splenic venous shunt; Warren shunt; Cirrhosis - distal splenorenal; Liver failure - distal splenorenal; Portal vein pressure - distal splenorenal shunt

Description

During DSRS, the vein from your spleen is disconnected from the portal vein. The vein is then attached to the vein to your left kidney. This helps reduce blood flow through the portal vein.

Why the Procedure Is Performed

The portal vein brings blood from the intestine, spleen, pancreas, and gallbladder to the liver. When blood flow is blocked, the pressure in this vein becomes too high. This is called portal hypertension. It often occurs due to liver damage caused by:

When blood can't flow normally through the portal vein, it takes another path. As a result, swollen blood vessels called varices form. The most important location for these is in the esophagus. They develop thin walls that can break and bleed into the esophagus and stomach.

You may have this surgery if imaging tests such as upper GI endoscopy or x-rays show that you have bleeding varices in the esophagus or stomach. DSRS surgery reduces pressure in the varices and helps control bleeding.

Risks

Risks for anesthesia and surgery in general are:

Risks of this surgery include:

Before the Procedure

Before the surgery, you may have certain tests:

Tell your surgeon or nurse if:

During the week before your surgery:

On the day of surgery:

After the Procedure

Expect to stay in the hospital after surgery to recover for 7 to 10 days.

When you wake up after the surgery you will have at least one or more of the following:

As you are able to eat and drink, you will be given liquids and food.

You may have an imaging test to see if the shunt is working.

You may meet with a dietitian, and learn how to eat a low-fat, low-salt diet.

Outlook (Prognosis)

After DSRS surgery, bleeding in the varices is controlled in most people with portal hypertension. The highest risk of bleeding again is in the first month after surgery.

References

Dudeja V, Ferrantella A, Fong Y. The liver. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 54.

Lee EJ, Wesson RN. Portal hypertension: role of shunting procedures. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 14th ed. Philadelphia, PA: Elsevier; 2023:413-417.


Review Date: 9/30/2024
Reviewed By: Jonas DeMuro, MD, Diplomate of the American Board of Surgery with added Qualifications in Surgical Critical Care, Assistant Professor of Surgery, Renaissance School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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