Creation of Distal Splenorenal Shunt

This chapter describes creation of a distal splenorenal shunt for the decompression of gastroesophageal varices in the setting of extrahepatic portal hypertension or intrahepatic portal hypertension when transplantation is not an option. The text includes an introduction that outlines the indications, risks, alternatives, essential steps needed, and variations in technique for the procedure. This summary is followed by a template operative dictation, which provides the reader with an operative report, such as is found in a patient chart or electronic medical record. A description is provided of the following critical concepts for this procedure: entrance into the lesser sac, ligation of large coronary and umbilical vein communications, preservation of the short gastric veins and left gastroepiploic vein, mobilization of the splenic vein and left renal vein, and end-to-side anastomosis of the distal splenic vein to the left renal vein.