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Objective: Determine the clinical outcome after distal splenorenal shunt (DSRS) surgery for recurrent variceal hemorrhage.
Design: Case series.
Setting:Tertiary care referral center
Patients: 41 consecutive patients with well-compensated cirrhosis who underwent DSRS at the Lahey Clinic between 9/1999 and 12/2011 were studied.
Interventions: Patients underwent DSRS surgery for recurrent variceal bleeding after failing medical therapy or previous transjugular intrahepatic portacaval shunt (TIPS) procedure.
Main Outcome Measures: Patient demographics, diagnosis, DSRS indication, hospital length of stay (LOS), perioperative complications, operative (30 day) mortality and morbididty rates, patient survival, shunt patency rate.
Results: 29 men and 12 woman (54.2+1.7 years), with end-staged liver disease (Child's A 80%, B 20%) underwent DSRS with hospital LOS of 9+0.9 days. 7 patients (17%) had previous failed TIPS prior to DSRS. Most common reason for cirrhosis was alcohol 36.6% and hepatitis C infection in 24.4%. Operative mortality was 4.8%, morbidity 39%, with one year survival 90.1%. Recurrent variceal bleeding was observed 2.4%, hepatic encephalopathy in 4.8% and ascites 12.2%. Overall DSRS shunt patency was 97.6%. Two patients underwent uneventful subsequent orthotopic liver transplantation 4 and 5 years after DSRS respectively.
Conclusions: DSRS is a safe and effective treatment for recurrent variceal bleeding in well-compensated cirrhotic patients who fail medical therapy or TIPS. Low operative mortality, acceptable morbidity and excellent patency rates can be expected in well-selected patients and does not affect subsequent liver transplant outcome. Well-compenstaed cirrhotic patients with recurrent variceal bleeding may derive more benefit from DSRS rather than TIPS or ongoing medical therapy.