Recent advances in the management of variceal bleeding.
A prospective randomized trial of selective distal splenorenal shunt (DSRS) versus H-graft interposition total shunt at Emory Hospital in 1971 showed DSRS to be superior to a total shunt in shunt patency, prevention of variceal bleeding, preserving hepatic cell function, preserving the quality of life and patient survival. These results were particularly evident in the non-alcoholic patients. In the alcoholic patients, there was a greater loss of hepatic portal perfusion. In a later phase of the study, it was found that pancreatic veins formed a pathway of collaterals to the shunt, that is a so-called pancreatic siphon. In order to prevent loss of portal and pancreatic flow through the siphon, a total spleno-pancreatic disconnection was developed, whereby the hormone diversion is expected to be diminished.
D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008102:Liver Circulation; D008108:Liver Diseases, Alcoholic / Q000150:complications; D008111:Liver Function Tests; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011897:Random Allocation; D013164:Splenorenal Shunt, Surgical / Q000379:methods