Long-term results of modified distal splenorenal shunts for the treatment of esophageal varices

Background/Aims: Long-term results were compared for 3 types of distal sple norenal shunt for the treatment of esophageal varices. Methodology: Between July 1983 and December 1997, 45 patients with esophage al varices underwent distal splenorenal shunt. Group 1 underwent standard d istal splenorenal shunt (n=11). Group 2 underwent distal splenorenal shunt with spleno-pancreatic disconnection (n=11). Group 3 underwent distal splen orenal shunt with splenopancreatic disconnection and gastric transection (n =23). Results: Additional treatment for recurrent varices was required in group 1 , (n=1, 9.1%), group 2 (n=2, 18.2%), and group 3 (n=1, 4.3%). All of the pa tients with recurrent varices developed a shunt stenosis within the 1st yea r after distal splenorenal shunt. The prevalence of hyperammonemia in group 1 was 40.0% at 1, 5, and 10 years. In group 2, the prevalence was 14.3% at 1 year, 31.4% at 5 years, and 54.3% at 10 years. In group 3, the prevalenc e was 0% at 1 year, and 9.1% at 5 and 10 years. The differences between gro up 3 and groups 1 and 2 were significant (P<0.01). The cumulative survival rates at 1 year were 90.9%, 63.6%, and 95.7% for groups 1,2, and 3, respect ively. At 10 years, the cumulative survivals rates were 70.7%, 63.6%, and 6 9.4% for groups 1, 2, and 3, respectively. There were no significant differ ences in survival between the 3 groups. Conclusions: Distal splenorenal shunt with splenopancreatic disconnection a nd gastric transection may reduce the incidence of postoperative hyperammon emia.