In medicine, a distal splenorenal shunt procedure (DSRS), also splenorenal shunt procedure and Warren shunt,Warren WD, Henderson JM, Millikan WJ, Galambos JT, Brooks WS, Riepe SP, Salam AA, Kutner MH. Distal splenorenal shunt versus endoscopic sclerotherapy for long-term management of variceal bleeding. Preliminary report of a prospective, randomized trial. Ann Surg. 1986 May;203(5):454-62. PMID 3486641. is a surgical procedure in which the distal splenic vein (a part of the portal venous system) is attached to the left renal vein (a part of the systemic venous system). It is used to treat portal hypertension and its main complication (esophageal varices).Boyer TD, Kokenes DD, Hertzler G, Kutner MH, Henderson JM. Effect of distal splenorenal shunt on survival of patients with primary biliary cirrhosis. Hepatology. 1994 Dec;20(6):1482-6. PMID 7982648.

Splenopancreatic and gastric disconnection (SPGD)

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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 system), as it improves the outcome.Hirano S, Kondo S, Ambo Y, Tanaka E, Morikawa T, Okushiba S, Katoh H. Appraisal of DSRS with SPGD for esophagogastric varices: a retrospective comparative study according to the underlying liver diseases. Hepatogastroenterology. 2005 Jan-Feb;52(61):152-5. PMID 15783017.

Comparison to TIPS

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Survival with a transjugular intrahepatic portosystemic shunt (TIPS) versus a DSRS is thought to be approximately similar,Rockey DC. Update on the Role of TIPS in the Management of Portal Hypertension. Medscape.com. URL: http://www.medscape.com/viewarticle/492983. Accessed on March 18, 2006. but still an area of intensive research.NIH. Multicenter Randomized Trial of DSRS versus TIPS. URL: http://www.surgery.wisc.edu/general/research/grants_rikkers_nih.shtml. Accessed on March 18, 2006.

DSCS appears to be more cost effective than TIPS.Zacks SL, Sandler RS, Biddle AK, Mauro MA, Brown RS Jr. Decision-analysis of transjugular intrahepatic portosystemic shunt versus distal splenorenal shunt for portal hypertension. Hepatology. 1999 May;29(5):1399-405. PMID 10216122.

References

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External links

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• Distal Splenorenal Shunt Procedure (Cleveland Clinic) - 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.

Medical treatments | Gastroenterology | General surgery