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 socalled 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.

Selective distal splenorenal shunt (DSRS) is superior to total shunts in shunt patency, prevention of variceal bleeding, preserving hepatic cell function, quality of life, and patient survival, particularly in non-alcoholic patients.

Recent advances in the management of variceal bleeding

Key Takeaway: Selective distal splenorenal shunt (DSRS) is superior to total shunts in shunt patency, prevention of variceal bleeding, preserving hepatic cell function, quality of life, and patient survival, particularly in non-alcoholic patients.