Advertisement

World Journal of Surgery

, Volume 43, Issue 2, pp 590–593 | Cite as

Coronary Renal Shunt with Splenectomy (CRSS) for Selective Variceal Decompression

  • Mingguo TianEmail author
  • Yong Yang
  • Dong Jia
Innovative Surgical Techniques Around the World
  • 32 Downloads

Abstract

Background

Distal splenorenal shunt and coronary caval shunt are commonly used for selective decompression of esophagogastric varices, but they may not solve severe hypersplenism and their application may be hampered by the presence of splenic venous thrombosis or a left gastric vein (LGV) situated deeply behind the pancreas. On the other hand, some patients have an LGV entering the splenic vein (SV). We tried to work out a new selective shunt for this group of patients.

Methods

Sixteen patients with severe hypersplenism and esophagogastric varices received coronary renal shunt using the SV following splenectomy. After splenectomy, the proximal portion of the SV and the LGV was isolated from the pancreas. The isolated SV was divided at a point 3–5 cm left to its junction with the LGV. The proximal orifice was anastomosed to the left renal vein, and the distal orifice was ligated. A clip was applied to the SV for occlusion between the portal vein and LGV. The right gastric and gastroepiploic vessels were divided to block backflow from the portal vein and to reduce the arterial inflow of the varices.

Results

No operative mortality or procedure-related complications occurred. Postoperative computed tomography and endoscopy showed that all the shunts were patent and that the varices had been obliterated or markedly alleviated. In the 6–36 months’ follow-up period, no recurrent variceal hemorrhage or encephalopathy occurred.

Conclusion

Coronary renal shunt combined with splenectomy can achieve the goal of selective decompression of esophagogastric varices. It would become an alternative means of selective variceal decompression for patients whose LGV enters the SV.

Notes

Acknowledgements

The authors wish to acknowledge Dr. Da Zhi Chen’s valuable help in image processing and the patients’ follow-up.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Pal S (2012) Current role of surgery in portal hypertension. Indian J Surg 74:55–66CrossRefGoogle Scholar
  2. 2.
    Lodge JP, Mavor AI, Giles GR (1990) Does the Warren shunt correct hypersplenism? HPB Surg 2:41–49CrossRefGoogle Scholar
  3. 3.
    Warren WD, Millikan WJ Jr, Henderson JM et al (1984) Selective variceal decompression after splenectomy or splenic vein thrombosis. Ann Surg 199:694–701CrossRefGoogle Scholar
  4. 4.
    Inokuchi K, Beppu K, Koyanagi N et al (1984) Fifteen years’ experience with left gastric venous caval shunt for esophageal varices. World J Surg 8:716–721.  https://doi.org/10.1007/BF01655768 CrossRefGoogle Scholar
  5. 5.
    Widrich WC, Srinivasan M, Semine MC et al (1984) Collateral pathways of the left gastric vein in portal hypertension. AJR Am J Roentgenol 142:375–382CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  1. 1.Department of Hepatobiliary SurgeryPeople’s Hospital of Ning Xia Hui Autonomous RegionYinchuan CityPeople’s Republic of China

Personalised recommendations