Clinical comparison between original and modified distal splenorenal shunts

This article reports on a retrospective clinical comparison between the original Warren shunt and one that we modified with Gore-Tex (expanded polytetrafluoroethylene) interposition. The former operation was performed on 35 patients between June 1969 and November 1983 and the latter on 29 patients between October 1983 and January 1986. There were no significant differences in the patients' backgrounds between the two study groups. Blood loss during surgery was significantly greater and operation time was longer in the original shunt group than in the modified shunt group. The incidence of postoperative morbidity and mortality was also significantly higher in the former group than in the latter (major complication rate: 20.0% versus 3.4%; operative death within 1 month: 5.7% versus 0%; in-hospital death: 11.4% versus 3.4%). The modified shunts had a 100% patency rate, and no variceal bleeding was evident, whereas shunt occlusion was observed in two patients and portal thrombosis in one patient of the original shunt group. The incidence of hepatic encephalopathy was 14.3% in the original shunt group and 6.9% in the modified shunt group, and the follow-up time was shorter in the latter group. A significantly greater rate of survival was achieved with the modified Warren shunts. Thus the current study seems to indicate that our modifications could be alternatives to the original distal splenorenal shunt in terms of postoperative morbidity, mortality, and survival.