Surgical Treatment: Selective Shunt Surgery

  • Hiroshi YoshidaEmail author
  • Hiroshi Makino
  • Tadashi Yokoyama
  • Hiroshi Maruyama
  • Atsushi Hirakata
  • Junji Ueda
  • Hideyuki Takata
  • Yasuhiro Mamada
  • Nobuhiko Taniai
  • Eiji Uchida


A number of surgical procedures have been developed for the management of esophagogastric varices. They can be broadry classified into shunting and nonshunting procedures. There are two types of shunting procedure, namely nonselective and selective. Nonselective shunts, such as portacaval or mesocaval shunts, effectively reduce the incidence of variceal bleeding, but they carry a high risk of postoperative encephalopathy as a result of hyperammonemia. Selective shunts such as the distal splenorenal shunt (DSRS) or left gastric venous caval shunt were developed to preserve portal blood flow through the liver and reduce esophagogastric variceal pressure. The DSRS effectively prevents rebleeding, but it still carries a risk of postoperative encephalopathy. In order to prevent both postoperative encephalopathy and bleeding, we have improved the DSRS procedure by additionally performing splenopancreatic disconnection and gastric transection.

In conclusion, endoscopic treatments have been developed recently and are performed widely performed for esophagogastric varices; however, surgery in the form of DSRS is also useful for managing esophagogastric varices in patients with idiopathic portal hypertension in the absence of severe liver pathologies.


Distal splenorenal shunt Esophagogastric varices Portal hypertension Selective shunt 


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Hiroshi Yoshida
    • 1
    Email author
  • Hiroshi Makino
    • 2
  • Tadashi Yokoyama
    • 2
  • Hiroshi Maruyama
    • 2
  • Atsushi Hirakata
    • 2
  • Junji Ueda
    • 2
  • Hideyuki Takata
    • 2
  • Yasuhiro Mamada
    • 1
  • Nobuhiko Taniai
    • 3
  • Eiji Uchida
    • 1
  1. 1.Department of SurgeryNippon Medical SchoolTokyoJapan
  2. 2.Department of SurgeryNippon Medical School Tama Nagayama HospitalTokyoJapan
  3. 3.Department of SurgeryNippon Medical School Musashi Kosugi HospitalTokyoJapan

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