title: Selective distal splenorenal shunt without requiring splenopancreatic disconnection with the use of the external iliac vein graft: a preliminary report.
abstract: BACKGROUND
  Distal splenorenal shunt (DSRS) with splenopancreatic disconnection (SPD) is an ideal operation for permanent control of variceal bleeding. However, it is a very complicated procedure, and DSRS without SPD has a functional 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 applied in 4 cases, and shunt patency and selectivity were examined by angiography during follow-up periods (6-76 months).
  
  
  RESULTS
  Modified DSRS was technically more feasible and less complicated than DSRS with SPD. Every attempt was successful. There was no operative mortality, and all the patients were discharged from the hospital in good condition. The shunts were patent in all of them, and the selectivity of the shunt was maintained better in comparison to standard DSRS.
  
  
  CONCLUSIONS
  Modified DSRS is a much easier and safer technique than standard DSRS. We consider this procedure to be the best method for surgical management of portal hypertension causing esophageal and gastric varices.
authors.affiliation: Second Department of Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kato
authors.forename: S
authors.initials: S
authors.lastname: Kondo
authors.forename: T
authors.initials: T
authors.lastname: Morikawa
authors.forename: S
authors.initials: S
authors.lastname: Okushiba
authors.forename: H
authors.initials: H
authors.lastname: Katoh
mesh_terms: D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000601:surgery; D007084:Iliac Vein / Q000637:transplantation*; D007668:Kidney / Q000601:surgery*; D010179:Pancreas / Q000098:blood supply / Q000601:surgery*; D013154:Spleen / Q000098:blood supply / Q000601:surgery*; D013162:Splenic Vein / Q000601:surgery