Extra peritoneal transposition of spleen in portal hypertension--a new operative technique

The author describes a procedure for portal circulation bypass in the treatment of esophageal varices. The systemic circulation is shunted with the spleen, which is transposed extraperitoneally and thus will have a raw area on its convex surface, to adhere to the exposed muscle of the diaphragm, inner intercostal muscles of the posterior abdominal wall. The portal blood is thus partly directed to the inferior phrenic vein and the intercostal veins and ultimately drains into the azygous systems. With this procedure the ascites fluid seeps out of the peritoneal cavity along the edges of the spleen and therefore has a larger absorption surface in the extraperitoneal space, apart from the improved suprahepatic portal drainage provided.