medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...

, a distal splenorenal shunt procedure (DSRS), also splenorenal shunt procedure and Warren shunt, is a

surgical procedure Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

in which the

distal Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...

splenic vein The spleen is an organ (biology), organ found in almost all vertebrates. Similar in structure to a large lymph node, it acts primarily as a blood filter. The word spleen comes .

(a part of the

portal venous system In the circulatory system of animals, a portal venous system occurs when a capillary bed pools into another capillary bed through veins, without first going through the heart. Both capillary beds and the blood vessels that connect them are co ...

) is attached to the left

renal vein The renal veins are large-calibre veins that drain blood filtered by the kidneys into the inferior vena cava. There is one renal vein draining each kidney. Because the inferior vena cava is on the right half of the body, the left renal vein is lo ...

(a part of the

systemic venous system The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, tha ...

). It is used to treat

portal hypertension Portal hypertension is abnormally increased portal venous pressure – blood pressure in the portal vein and its branches, that drain from most of the intestine to the liver. Portal hypertension is defined as a hepatic venous pressure gradient gr ...

and its main complication (

esophageal varices Esophageal varices are extremely dilated sub-mucosal veins in the lower third of the esophagus. They are most often a consequence of portal hypertension, commonly due to cirrhosis. People with esophageal varices have a strong tendency to develop ...

). It was developed by W. Dean Warren.

Splenopancreatic and gastric disconnection (SPGD)

DSRS is typically done with splenopancreatic and gastric disconnection (ligation of the gastric veins and

pancreatic vein In human anatomy, the pancreatic veins consist of several small blood vessels which drain the body and tail of the pancreas, and open into the trunk of the great pancreatic vein. References

Veins of the torso {{circulatory-stub ...

s (that drain into the

portal vein The portal vein or hepatic portal vein (HPV) is a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. This blood contains nutrients and toxins extracted from digested contents. Approxima ...

) and complete detachment of the

splenic vein The spleen is an organ (biology), organ found in almost all vertebrates. Similar in structure to a large lymph node, it acts primarily as a blood filter. The word spleen comes .

from the

), as it improves the outcome.

Comparison to TIPS

Survival with a

transjugular intrahepatic portosystemic shunt Transjugular intrahepatic portosystemic shunt (TIPS or TIPSS) is an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein. It is used to treat portal hypertension (which is ...

(TIPS) versus a DSRS is thought to be approximately similar, but still an area of intensive research. Both TIPS and DSRS lead to decreased rates of

variceal bleed Esophageal varices are extremely dilated sub-mucosal veins in the lower third of the esophagus. They are most often a consequence of portal hypertension, commonly due to cirrhosis. People with esophageal varices have a strong tendency to develop s ...

ing at the expense of

hepatic encephalopathy Hepatic encephalopathy (HE) is an altered level of consciousness as a result of liver failure. Its onset may be gradual or sudden. Other symptoms may include movement problems, changes in mood, or changes in personality. In the advanced stages ...

; however, TIPS appears to have more shunt dysfunction and lead to more encephalopathy and bleeds. DSRS appears to be more cost effective than TIPS.

References

External links

Distal Splenorenal Shunt Procedure
(

Cleveland Clinic Cleveland Clinic is a nonprofit American academic medical center based in Cleveland, Ohio. Owned and operated by the Cleveland Clinic Foundation, an Ohio nonprofit corporation established in 1921, it runs a 170-acre (69 ha) campus in Cleveland, ...

) - has some schematics that show what is done in the procedure.
Portal Hypertension
(Mohawk Valley Vascular Center) - has some schematics that show what is done in the procedure. {{Vascular surgery procedures Digestive system surgery General surgery Vascular surgery