Modification of splenorenal shunt using adrenal vein as a Conduit: Proximal spleno-adrenorenal shunt

Proximal splenorenal shunt (PSRS) is an established treatment for non-cirrhotic portal hypertension (NCPH). Proximal splenoadrenorenal shunt (PSARS), utilizing adrenal vein as a conduit is an alternative technique for shunting blood from the splenic vein to the renal vein, with several advantages.

A retrospective analysis of 128 PSRS and 94 PSARS patients between January2008 and December2023 was done.

Etiology, presentation, haematological parameters, doppler ultrasound and pre-operative endoscopic findings were comparable. Median intraoperative portal pressure decrement between PSRS (10 ​mmHg) and PSARS (9 ​mmHg) was comparable (p ​= ​0.373). Intraoperative blood loss (p ​= ​0.499), surgery duration (p ​= ​0.159), and morbidity (p ​= ​0.421) were comparable. At median follow-up of 56 (6-87)months for 207 ​pts, the rate of rebleed (5 %vs3.4 ​%; p ​= ​0.110), variceal grade decrease (96.2 ​% vs 95.7 ​%; p ​= ​1.014) and improvement of portal biliopathy (70.9 %vs71.4 ​%; p ​= ​0.418) were comparable.

Results of PSARS & PSRS are comparable. With it's attendant benefits, whenever feasible PSARS is advocated as the preferred alternative.