[Improvement of selectivity of distal splenorenal shunt and its clinical analysis]

Follow up studies of 96 patients who underwent distal splenorenal shunt (DSRS) were performed and the loss of selectivity of DSRS was evaluated. We have established the indications for DSRS since 1980 and modified the procedures for DSRS--complete or incomplete splenopancreatic disconnection of the splenic vein (SPD)--since 1981. Twenty two of 47 patients operated before 1980 and 9 of 49 patients operated after 1980 were died of liver failure, being statistically significant (p less than 0.05). There were no significant differences in the incidence of development of encephalopathy before and after 1980 (7 patients before 1980 and 6 patients after 1980). Twenty eight of 69 patients without SPD and one of 16 patients with incomplete SPD were died of liver failure, being statistically significant (p less than 0.025). Twelve of 69 patients without SPD developed encephalopathy, while none of 27 patients with complete or incomplete SPD developed encephalopathy (p less than 0.05). It was suggested, therefore, that our established indications and DSRS with complete or incomplete SPD might be suitable for the selective shunt operation for esophageal varices.