Surgical Treatment: Selective Shunt Surgery

A number of surgical procedures have been developed for the management of esophagogastric varices. They can be broadry classified into shunting and nonshunting procedures. There are two types of shunting procedure, namely nonselective and selective. Nonselective shunts, such as portacaval or mesocaval shunts, effectively reduce the incidence of variceal bleeding, but they carry a high risk of postoperative encephalopathy as a result of hyperammonemia. Selective shunts such as the distal splenorenal shunt (DSRS) or left gastric venous caval shunt were developed to preserve portal blood flow through the liver and reduce esophagogastric variceal pressure. The DSRS effectively prevents rebleeding, but it still carries a risk of postoperative encephalopathy. In order to prevent both postoperative encephalopathy and bleeding, we have improved the DSRS procedure by additionally performing splenopancreatic disconnection and gastric transection.