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Martin A. Adson, MD; Jonathan A. van Heerden, MB, FRCS(C); Duane M. Ilstrup, MS

Arch Surg. 1984;119(5):609-614.

Abstract
• Our initial use of the distal splenorenal shunt (DSRS) in 1973 was fostered by disappointment with the results of so-called total shunts. This selective shunt was, when anatomically feasible, our preferred therapy until 1980, when surgical referral was affected by enthusiasm for sclerotherapy. Our study of 71 DSRSs is uncontrolled because we could not recruit patients for a prospective randomized trial that involved either no treatment or operations that had proven faults. Our experience shows that operative risk (4%) and incidence of postshunt encephalopathy (6%) are low, that the rate of shunt occlusion is acceptable (10%), and that bleeding is as well controlled as with other shunts. Survival rates correlate with the cause of portal hypertension and with hepatic functional reserve. Analysis of the causes of death shows that the natural history of cirrhosis and coexistent disease are major determinants of prognosis.

(Arch Surg 1984;119:609-614)

Author Affiliations
From the Section of Gastroenterologic and General Surgery (Drs Adson and van Heerden) and the Department of Medical Statistics and Epidemiology (Mr Ilstrup), Mayo Clinic and Mayo Foundation, Rochester, Minn.

Footnotes
Accepted for publication Jan 11, 1984.

Read before the 91st annual meeting of the Western Surgical Association, Monterey, Calif, Nov 16, 1983.

Reprint requests to Mayo Clinic, 200 First St SW, Rochester, MN 55905 (Dr Adson).

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