Distal splenorenal shunt

A distal splenorenal shunt (DSRS) is a type of surgery done to relieve extra pressure in the portal vein. The portal vein carries blood from your digestive organs to your liver.

Description

During DSRS, the vein from your spleen is removed from the portal vein. The vein is then attached to the vein to your left kidney. This helps reduce blood flow through the portal vein.

Why the Procedure is Performed

The portal vein brings blood from the intestine, spleen, pancreas, and gallbladder to the liver. When blood flow is blocked, the pressure in this vein becomes too high. This is called portal hypertension. It often occurs due to liver damage caused by:

• Alcohol use
• Chronic viral hepatitis

  Chronic viral hepatitis

  Hepatitis is swelling and inflammation of the liver.

   

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• Blood clots
• Certain congenital disorders
• Primary biliary cirrhosis (liver scarring caused by blocked bile ducts)

  Primary biliary cirrhosis

  The bile ducts are tubes that move bile from the liver to the small intestine. Bile is a substance that helps with digestion. All of the bile ducts...

   

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When blood can't flow normally through the portal vein, it takes another path. As a result, swollen blood vessels called varices form. They develop thin walls that can break and bleed.

You may have this surgery if imaging tests such as endoscopy or x-rays show that you have bleeding varices. DSRS surgery reduces pressure on the varices and helps control bleeding.

Risks

Risks for anesthesia and surgery in general are:

• Allergic reactions to medicines or breathing problems

  Breathing problems

  Breathing difficulty may involve:Difficult breathingUncomfortable breathingFeeling like you are not getting enough air

   

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• Bleeding, blood clots, or infection

Risks of this surgery include:

• Buildup of fluid in the belly (ascites)
• Repeat bleeding from the varices
• Encephalopathy (loss of brain function because the liver is unable to remove toxins from the blood)

  Encephalopathy

  Loss of brain function occurs when the liver is unable to remove toxins from the blood. This is called hepatic encephalopathy. This problem may occ...

   

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Before the Procedure

Before the surgery, you may have certain tests:

• Angiogram (to view inside the arteries)
• Blood tests
• Endoscopy

  Endoscopy

  Endoscopy is a way of looking inside the body using a flexible tube that has a small camera and light on the end of it. This instrument is called an...

   

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• Galactose liver function test

Give your health care provider a list of all the medicines you take (prescription and over-the-counter), herbs, and supplements. Ask which ones you need to stop taking before the surgery, and which ones you should take the morning of the surgery.

Your provider will explain the procedure and tell you when to stop eating and drinking before the surgery.

After the Procedure

Expect to stay 7 to 10 days in the hospital after surgery to recover.

When you wake up after the surgery you will have:

• A tube in your vein (IV) that will carry fluid and medicine into your bloodstream
• A catheter in your bladder to drain urine
• An NG tube (nasogastric) that goes through your nose into your stomach to remove gas and fluids
• A pump with a button you can press when you need pain medicine

As you are able to eat and drink, you will be given liquids and food.

You may have an imaging test to see if the shunt is working.

You may meet with a dietitian, and learn how to eat a low-fat, low-salt diet.

Outlook (Prognosis)

After DSRS surgery, bleeding is controlled in most people with portal hypertension. The highest risk of bleeding again is in the first month after surgery.