Retroperitoneal approach to the Warren shunt

The Warren shunt, despite its recognized attributes, has several major obstacles to gaining widespread acceptance in the surgical community. These include its technical difficulty and the increased incidence of postoperative ascites. We have begun using a retroperitoneal approach for the performance of this procedure, which we believe is technically easier and may lessen postoperative ascites. In addition, blood loss, the need for ventilatory support and intensive care, and the occurrence of postoperative ileus have all been reduced in our experience. Herein, we have reported the details of this approach and discussed its major advantages over the classic transperitoneal approach to the distal splenorenal shunt.