The Clinical Evaluation of Gastric Disconnection in Selective Distal Splenorenal Shunt

Kimihiro Nakajima, Hiroyuki Kato, Shunichi Okushiba, Tetsufumi Kojima, Eiji Shimozawa, Tatsuzo Tanabe

The Second Department of Surgery, Hokkaido University School of Medicine

A modified selective distal splenorenal shunt (DSRS) with splenopancreatic gastric disconnection (SPGD) was evaluated in patients with portal hypertension. DSRS with SPGD is believed to isolate the stomach from the collateral portal circulation more completely than without SPGD. Six patients underwent standard DSRS (incomplete group) and 18 patients underwent DSRS with SPGD (complete group). In the complete group, the portal perfusion grade (PPG)remained low, but the postoperative portal vein/superior mesenteric vein diameter was significantly lower after the operation and collateral pathways were demonstrated in the incomplete group only. On the other hand, in the complete group, the portal perfusion grade was good in the late period. In conclusion, the addition of SPGD to DSRS maintains portal vein perfusion flow and shunt selectivity.

Key words
portal hypertension, esophageal varices, distal splenorenal shunt, angiography

Reprint requests
Kimihiro Nakajina The Second Department of Surgery, Hokkaido University School of Medicine
Kita 15 Nishi, 7, Kita-ku, Sapporo, 060 JAPAN

Accepted
March 13, 1991

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