[Late results of Warren's distal splenorenal shunt]

To assess the long term results of the Warren distal splenorenal shunt, 53 patients suffering from chronic liver disease and managed with such a procedure from 1975 to 1981 for bleeding esophageal varices were evaluated. No rebleeding occurred after the immediate postoperative period. Five-year survival was 62 +/- 13 p. 100. No difference in survival was found between alcoholic cirrhotics and patients without any history of alcohol abuse. Of the 28 six-year survivors, 24 accepted endoscopy, which confirmed the absence of esophageal varices. Thirteen patients accepted mesenteric angiography; all had a patent shunt and significant hepatofugal collateral flow. Although reduced portal perfusion was maintained in 10 patients. Severe chronic encephalopathy occurred in 3 patients who had important hepatofugal collateral flow. At 5 years, operation resulted in a significant increase of the mean leucocyte and platelet counts in patients who had preoperative hypersplenism (p less than 0.001). In conclusion our data confirm the long term efficiency of the Warren distal splenorenal shunt in decompression of esophageal varices. Despite the development of hepatofugal collateral veins, portal perfusion is preserved in most cases, and disabling encephalopathy is rare.