Intraoperative direct portography to achieve selective distal splenorenal shunt

Repeated direct portography was performed during distal splenorenal shunt in 13 consecutive patients with esophageal varices due to cirrhosis of the liver. The roentgenogram taken at the completion of all operative procedures demonstrated incomplete disconnection between the mesentericoportal and gastrosplenic compartments in four patients. After further disconnection of the veins, the third portogram showed a successful isolation of both systems. The flow state through and the size of the shunt were appropriate in all instances on the roentgenograms. The shunt was patent in all patients, which was confirmed before discharge from the hospital. Hepatic encephalopathy was encountered one year after operation in one patient with the poorest hepatic functions. Esophageal varices disappeared or nearly disappeared at the time of discharge in ten patients. The remaining varices at discharge in another three patients completely disappeared within six months after operation. None of the patients experienced variceal bleeding during the follow-up period of three to 25 months. The results may indicate that repeated intraoperative direct portography is useful in achieving a selective distal splenorenal shunt.