Long-term results after modified distal splenorenal shunt with expanded PTFE interposition

Area of Science:

• Hepatology
• Surgical Gastroenterology
• Vascular Surgery

Background:

• Esophagogastric varices are a serious complication of portal hypertension.
• Distal splenorenal shunt (DSS) is a surgical option for managing these varices.
• The Warren shunt is a traditional method, but modifications aim to improve safety and efficacy.

Purpose of the Study:

• To evaluate the safety and efficacy of a modified distal splenorenal shunt (mDSRS) with expanded polytetrafluoroethylene (PTFE) interposition.
• To assess shunt patency, bleeding recurrence, hepatic encephalopathy, and survival rates in patients with esophagogastric varices.

Main Methods:

• A consecutive series of 40 patients with esophagogastric varices underwent the modified DSS procedure.
• Patients were followed up for 12 to 66 months (mean 44.7 months).
• Data collected included operative details, complications, shunt patency, and survival.

Main Results:

• The operative mortality rate was 5%, with a 2.5% mortality within 1 month.
• Shunt patency was high at 97.2% early and 100% late.
• Upper gastrointestinal bleeding occurred in only 2.5% of patients. Hepatic encephalopathy was observed in 20.5% of survivors.
• The 1-, 3-, and 5-year survival rates were 87.4%, 73.3%, and 48.8%, respectively.

Conclusions:

• The modified DSS with PTFE interposition is a safe and technically feasible procedure for esophagogastric varices.
• It achieves high shunt patency and reduces rebleeding effectively.
• Despite its benefits, the procedure does not eliminate the risk of hepatic encephalopathy and liver failure, suggesting limitations for long-term management.