Recent advances in the management of variceal bleeding

• Published in: Japanese journal of surgery Vol. 16; no. 2; p. 77
• Main Authors: Warren, W D, Whitehead, J B
• Format: Journal Article
• Language: English
• Published: Japan 01.03.1986
• Subjects: Esophageal and Gastric Varices - surgery; Follow-Up Studies; Gastrointestinal Hemorrhage - surgery; Humans; Hypertension, Portal - complications; Liver Circulation; Liver Diseases, Alcoholic - complications; Liver Function Tests; Postoperative Complications - etiology; Prospective Studies; Random Allocation; Splenorenal Shunt, Surgical - methods
• ISSN: 0047-1909
• DOI: 10.1007/BF02471075

A prospective randomized trial of selective distal splenorenal shunt (DSRS) versus H-graft interposition total shunt at Emory Hospital in 1971 showed DSRS to be superior to a total shunt in shunt patency, prevention of variceal bleeding, preserving hepatic cell function, preserving the quality of life and patient survival. These results were particularly evident in the non-alcoholic patients. In the alcoholic patients, there was a greater loss of hepatic portal perfusion. In a later phase of the study, it was found that pancreatic veins formed a pathway of collaterals to the shunt, that is a so-called pancreatic siphon. In order to prevent loss of portal and pancreatic flow through the siphon, a total spleno-pancreatic disconnection was developed, whereby the hormone diversion is expected to be diminished.