The Warren (distal splenorenal) shunt for portal hypertension

The Warren distal splenorenal shunt, designed to decompress esophagogastric varices selectively while preserving portal venous inflow to the liver, was performed in 18 patients who had bled from esophageal varices. In 14 cirrhosis was micronodular, in 3 it was macronodular, and in 1 primary biliary. Two patients died within 1 month of surgery (operative mortality, 11%). Three patients died between 2 and 12 months after operation (1-year mortality, 28%). All five patients who died within 1 year had severe liver disease at the time of operation. None sustained further hemorrhage. Only one survivor requires protein restriction and none have fluid retention.