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Updated: Aug 13, 2026
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Published on: June 18, 2020
Selective and nonselective shunts for variceal bleeding. A prospective study of 103 patients
Insights
For recurrent bleeding varices, nonoperative treatments are not definitive. An elective distal splenorenal shunt offers a better quality of life and is the preferred surgical option for managing variceal hemorrhage.
Area of Science:
- Gastroenterology
- Hepatology
- Surgical Gastroenterology
Background:
- Bleeding varices represent a serious complication of portal hypertension.
- Nonoperative management and nonselective shunts have limitations in treating recurrent variceal hemorrhage.
Purpose of the Study:
- To evaluate the efficacy of selective shunts compared to nonoperative means and nonselective shunts for recurrent variceal hemorrhage.
- To establish the distal splenorenal shunt as the elective procedure of choice.
Main Methods:
- Retrospective analysis of patient outcomes following various treatments for bleeding varices.
- Comparison of complication rates, particularly encephalopathy, and survival between selective and nonselective shunts.
Main Results:
- Nonoperative treatments are not definitive for recurrent variceal bleeding.
- Selective shunts, specifically the distal splenorenal shunt, are associated with lower encephalopathy rates and improved quality of life.
- Nonselective shunts have similar survival but higher encephalopathy rates, reserving them for specific emergency or complex cases.
Conclusions:
- The elective distal splenorenal shunt is the optimal surgical treatment for recurrent variceal hemorrhage.
- Shunt surgery, when well-planned, offers low mortality, long-term patency, and significant survival, remaining the gold standard.
Abstract:
Based on the experience reported herein, the following conclusions have been made: (1) Although nonoperative means, including sclerotherapy, have an important role in the management of bleeding varices, they are not definitive means of treating recurrent variceal hemorrhage. (2) Because of the maintenance of hepatopetal flow and splanchnic venous hypertension, a selective shunt is associated with a lower incidence of encephalopathy and provides a better quality of life than does a nonselective shunt. Thus, an elective distal splenorenal shunt is the elective operation of choice for recurrent variceal hemorrhage. (3) Nonselective shunts can be performed with similar expectation of patient survival as selective shunts, but because of increased encephalopathy, should be reserved for emergency operations, in cases of unsuitable venous anatomy, and in those patients with intractable ascites. (4) A well-conceived elective shunt procedure can be performed with low operative mortality and long-term patency, results in significant survival, and is still considered the "gold standard" for treatment of variceal bleeding.
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