Surgical outcomes of distal splenorenal shunt or liver transplantation in treatment of schistosomal refractory variceal bleeding. Wael Mohialddin Ahmed Doush1. the distal splenorenal shunt (dsrs) is a surgical procedure during which the vein from the spleen (called the splenic vein) is detached from the portal vein and. the distal splenorenal shunt (dsrs) procedure provides good long-term control of bleeding in many people with portal hypertension. dsrs controls bleeding in.

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The relevant data pertaining to the 2 groups were subjected to statistical analysis with use of the Student’s t -test for independent samples Disfal release 5. As ultrasonography is the preferred initial test which can diagnose the presence of portocollateral vessels[ 30 ].

Portal hypertension is a condition characterized by increased pressure in the portal vein the vein that carries blood from the digestive organs to the liver. Sign in to access splenordnal subscriptions Sign in to your personal account. Also, it helped in regression of periportal fibrosis.

Distal splenorenal shunt procedure – Wikipedia

Currently, Van Buuren et al. Either endoscopic sclerotherapy or endoscopic band ligation can be practiced and the recommendation for endoscopic band ligation as first-line treatment achieved by elastic bands maximally per session every weeks until the variceal obliteration or small varices ligation become impossible.

Recurrent variceal bleeding despite endoscopic and medical therapy. Sixteen patients had hypersplenism, 9 had massive splenomegaly, and 4 had ascites. If small esophageal varices detected screening endoscopy must be spleonrenal every two years. Schistosoma mansoni infection in the liver graft: A number of recent clinical studies were compared surgical shunting with TIPS in xistal management of refractory variceal bleeding reported that DSRS has significantly lower rebleeding rate and encephalopathy than TIPS[ ].


Fusion fasciae derive their name from their developmental roots; they originate from the fusion of various membranes. Herein, we describe the advantages of our simplified procedure and recommend its use, especially in those regions of the world where portal hypertension is relatively common. Splenprenal the Spldnorenal procedure, after the ligation of the splenic artery, the tail and body of the pancreas are reflected to the right and cephalad, thereby exposing the splenic vein.

Propanolol reduced portal pressure and blood flow within it through the decreased cardiac output beta one receptor blockage and arteriolar splanchnic vasoconstriction beta two receptor blockage [ 63 ]. Our study confirms that DSRS can be performed in select patients with low operative mortality and dietal 6.

It complicated by thrombosis, stenosis and encephalopathy through portal flow diversion from the liver. Octreotide infusion and endoscopic sclerotherapy or banding is used initially in all patients presenting with variceal bleeding.

A Simplified Technique of Performing Splenorenal Shunt (Omar’s Technique)

Current management of the complications of cirrhosis and portal hypertension: The primary indication for DSRS was recurrent variceal bleeding. Privacy Policy Terms of Use. dsital

Sequential variceal pressure measurement by endoscopic needle spleenorenal during maintenance sclerotherapy: DSRS is typically done with splenopancreatic and gastric disconnection ligation of the gastric veins and pancreatic veins that drain into the portal vein and complete detachment of the splenic vein from the portal venous systemas it improves the outcome. Surgical shunts, particularly proximal splenorenal shunts, are an excellent choice for the control of chronic variceal bleeding. Long-term complications included recurrent variceal bleeding and hepatic encephalopathy, which occurred in 6.

Chronic human schistosomiasis mansoni. Adult liver transplantation and abnormalities of splanchnic veins: DSRS; Distal splenorenal shunt procedure; Renal – splenic venous shunt; Warren shunt; Cirrhosis – distal splenorenal; Liver failure – distal splenorenal; Portal vein pressure – distal splenorenal shunt.


It desirable to divide left adrenal vein which achieves mobilization of the left renal vein and bring it up into a side-biting vascular clamp for anastomosis without tension with leaving the left gonadal vessel intact diatal serve as an outflow tract [Figure 11] [, ].

After the simplified shunt operation has been completed, the tail of the pancreas, which is now unattached to the adjacent fascial tissue, is not dragged down to overlie the site of anastomosis—as may occur in the Cooley and Linton procedures—but instead remains well above it Fig.

Distal Splenorenal Shunt

Group I consisted of 6 male and 4 female patients with a mean age of Although splenectomy can reverse the thrombocytopenia, slenorenal procedure should be avoided in children. This is called portal hypertension.

By Angio-MRI the risk of variceal bleeding in patients can be evaluated through azygos blood flow measurement. The backup of pressure also causes the spleen to become enlarged.

The goal should be to maintain the functional reserve of the remaining liver while minimizing recurrent bleeding without compromising the ability to perform a remedial transplantation.

After the two veins properly approximated, the stay sutures were placed at either end and anastomosis is made with a running suture of prolene in a posterior row while an anterior row of the anastomosis completed with interrupted sutures to prevent a purse-string effect of the running suture [ Figures 16 and 17 ] [].

Atlas of vascular surgery. Effects of somatostatin on hepatic and systemic hemodynamics in patients with cirrhosis of the liver: Anti-inflammatory drugs and variceal bleeding: