A COMPARISON OF THE METABOLIC CHANGES AFTER THE DISTAL SPLENOCAVAL AND PORTACAVAL SHUNTS

The distal splenorenal shunt (DSRS) is the recommended procedure for s elective variceal decompression, but its use may be limited in patient s who have undergone left nephrectomy, those with an anatomically aber rant relationship between the splenic and left renal veins, and those whose preoperative angiographic findings suggest a risk of developing postoperative renal vein hypertension. For these clinical situations, the selective distal splenocaval shunt (DSCS) is a useful alternative to the DSRS. However, the metabolic consequences of the DSCS have not yet been studied in detail and therefore, using a canine model, the me tabolic changes following the DSCS and the portacaval shunt (Eck) were compared. The metabolic changes observed following the Eck were hyper ammonia and amino acid imbalance, while those following the DSCS were similar to those of the control dogs. In terms of the hepatic adenosin e triphosphate level, which reflects hepatic mitochondrial function, t he DSCS dogs were also similar to the control dogs. These data suggest that there was no metabolic disadvantage of the DSCS compared to the control.