Selective distal splenorenal shunt without requiring splenopancreatic disconnection with the use of the external iliac vein graft: A preliminary report

Background. Distal splenorenal shunt (DSRS) with splenopancreatic disconnec tion (SPD) is an ideal operation for permanent control of variceal bleeding . However, it is a very complicated procedure, and DSRS without SPD has a f unctional disadvantage. It gradually loses its selectivity and portal blood flow. To overcome these conditions, we designed a new technique - modified DSRS, which is easy to perform and maintains long-term selectivity of the shunt. Methods. Modified DSRS was performed by using an external iliac vein graft without treating small pancreatic tributaries of the splenic vein. It was a pplied in 4 cases, and shunt patency and selectivity were examined by angio graphy during follow-up periods (6-76 months). Results. Modified DSRS was technically more feasible and less complicated t han DSRS with SPD. Every attempt was successful. There was no operative mor tality, and all the patients were discharged from the hospital in good cond ition. The shunts were patent in all of them, and the selectivity of the sh unt was maintained better in comparison to standard DSRS. Conclusions. Modified DSRS is a much easier and safer technique than standa rd DSRS. We consider this procedure to be the best method for surgical mana gement of portal hypertension causing esophageal and gastric varices.