Surgical outcomes of distal splenorenal shunt or liver transplantation in treatment of schistosomal refractory variceal bleeding. Wael Mohialddin Ahmed Doush1. the distal splenorenal shunt (dsrs) is a surgical procedure during which the vein from the spleen (called the splenic vein) is detached from the portal vein and. the distal splenorenal shunt (dsrs) procedure provides good long-term control of bleeding in many people with portal hypertension. dsrs controls bleeding in.

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This procedure can be performed by an expert radiologist and is associated with low morbidity rates, even among splnorenal patients. Footnotes Address for reprints: Hemodynamic effects of the administration of terlipressin alone or combined with nitroglycerin in patients with cirrhosis.

When blood can’t flow normally through the portal vein, it takes another path.

Ultrasonographical investigation of periportal fibrosis in children with Schistosoma mansoni infection: Hepatic encephalopathy after transjugular intrahepatic portosystemic shunts: Vascular Diseases Read more. Successful living-related partial liver transplantation to an adult patient.

The evolution of portal hypertension surgery: Then described terminal spine mature ova and lateral spine immature ova, produced by the female worms[ 1112 ]. Because splenorenal shunts are performed fairly frequently in India and other developing countries, and because Sgunt procedure is associated with several inherent difficulties, we developed an alternative technique Omar’s technique for the surgical treatment of portal hypertension.

Distal splenorenal shunt procedure

Dietary suggestions will follow after the surgery. On the other hand, the hepatic living donor grafts have splenorenao distinct advantages when compared with deceased donor grafts including of better graft function, shorter cold-ischemia time and help in early transplantation [ Figures 21 and 22 ] [ ].


The rebleeding time frame calcified into very early rebleeding that occur within 5 days of acute bleedingearly rebleeding within 6 weeks of acute bleeding and delayed rebleeding. The goal should be to maintain the functional reserve of the remaining liver while minimizing recurrent bleeding without compromising the shut to perform a remedial transplantation.

Cardiopulmonary bypass Cardioplegia Extracorporeal membrane oxygenation Vascular access Revascularization First rib resection Seldinger technique Vascular snare. Then the splenic vein is dissected initially along its inferior and posterior edge cleared from peritoneum in pancreatic bed and continued medially toward its confluence with superior mesenteric vein until sufficient length was available for coming down to anastomose dplenorenal left renal vein without kinking [Figure 9].

A Simplified Technique of Performing Splenorenal Shunt (Omar’s Technique)

The disease is believed to affect approximately million individuals in many countries and kills more thanpeople per year, with most cases occurring in Africa, the Eastern Mediterranean and the Americas [Figure 2]. Surgical anatomy of the pancreas for limited resection. Seven of 81 patients were unavailable for follow-up and were excluded from statistical analysis. Cochrane Database Syst Rev 4: The control of schistosomiasis: Br J Surg ; Liver transplantation-living recipient graft.

It desirable to divide left adrenal vein which achieves mobilization of the left renal vein and bring it up into a side-biting vascular clamp for anastomosis without tension with leaving the left gonadal vessel intact which serve as an outflow tract [Figure 11] [, ].

Retrieved from ” https: Ligation of small venous tributaries that arise from the pancreas and entering into the splenic vein. Diagnosis of pathologically confirmed Symmers’ periportal fibrosis by ultrasonography: Before diagnostic endoscopy intravenous vasoactive therapy must start urgently with 2 mg every 4 h for the first 48 h and maintained for 5 days using 1 mg of terlipressin every 4 h to prevent rebleeding or somatostatin mg bolus dose followed by mg infused hourly as the second choice for 5 days.


The authors would like to thank Prof. The small bowel was isolated in sponge outside the abdominal cavity and the transverse colon retracted inferiorly while the stomach retracted superiorly. Abstract The splenorenal shunt procedure introduced by Robert Linton in is still used today in those regions of the world where portal hypertension is a common problem.

Lu Liu Production Editor: Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. Hence, oral norfloxacin mg twice daily for 7 days was recommended to improve survival and usage of lactulose is mandatory for encephalopathy prevention[ 61627980 ].

Because the blood flows away from the liver in patients with portal hypertension, the bleeding resulting from any proximal vascular injury splenorrnal be controlled easily by applying manual pressure or by using vascular clamps distally Fig.

A proximal splenorenal shunt procedure is advantageous because it avoids the need for a prosthetic graft, does not violate the porta and the right upper quadrant, is more effective in relieving any associated hypersplenism, 8 and seems to be better at controlling ascites.