Distal splenorenal shunt

Overview

Distal splenorenal shunt (DSRS) is a surgical procedure designed to alleviate the effects of portal hypertension by reducing pressure in the portal vein. This vein transports blood from the digestive organs to the liver. While DSRS cannot cure portal hypertension, it effectively manages symptoms such as bleeding by redirecting blood flow away from the portal vein. This surgical diversion helps decrease pressure and swelling in the portal system while ensuring adequate blood supply to the liver.

During DSRS, the surgeon disconnects the splenic vein (which connects the spleen to the portal vein) and reattaches it to the left kidney vein (renal vein). This creates a new pathway for blood circulation, bypassing the congested portal vein. Regular post-operative monitoring and follow-up care are essential to assess the procedure’s effectiveness and to maintain overall health in patients undergoing DSRS.

Reasons for undergoing the procedure

Portal hypertension may lead to various complications, prompting your healthcare provider to consider DSRS if tests reveal enlarged or bleeding veins in your stomach or esophagus. Other issues associated with portal hypertension include:

• Ascites (fluid buildup in the abdomen).
• Edema (swelling in the legs and feet).
• Blood in vomit or bowel movements (rectal bleeding).
• Gastrointestinal bleeding.
• Enlarged spleen (hypersplenism).
• Low blood oxygen levels (hypoxemia).
• Kidney failure.
• Mild cognitive impairment (MCI).

Risks

In general, distal splenorenal shunt surgery is a secure and successful process. You are most at risk of bleeding again within the first month following surgery. To help you control your risk and stay safe, your doctor will collaborate with you.

Before the procedure

Usually, your doctor does a physical examination as well as inquiries regarding your medical history. Tests are also performed to assess your general health, the function of your liver, and the severity of your portal hypertension.

Tests could consist of:

• Blood tests
• Chest X-ray
• Liver function tests
• Electrocardiogram (EKG)
• Upper endoscopy
• Angiogram

You receive instructions from your doctor on how to get ready for DSRS, which include:

• Which drugs to quit taking.
• Things to pack for the hospital.
• The appropriate time to quit drinking or eating.

To feel at ease and prepared, discuss any questions or concerns you may have with your provider.

During the procedure

Usually, DSRS takes four hours or so. You are first put under general anesthesia. Throughout the process, you are unconscious and experience no pain. Next, the surgical care group:

• Cuts the vein from your portal vein that is connected to your spleen.
• The vein is attached to your left kidney.

After the procedure

In the hospital, you usually recuperate for a week to ten days. Your doctor:

• Inserts a temporary catheter to drain your bladder.
• Inserts a nasogastric (NG) tube into your nose and stomach for a 24-hour period in order to remove fluids and gas.
• Places an IV in your neck to administer water and medication.
• Equips you with a pain management pump that you can control.

After surgery, you have an angiography one week later to check on the functionality of your shunt. When you are able to eat and drink, you obtain solid foods and liquids. You also have a meeting with a dietitian before to going back home. Your nutritionist could suggest a low-fat, low-sodium diet.

Outcome

To optimize your recovery, adhere to the advice from your healthcare provider and dietitian. Discuss with your provider when you can resume your regular activities and exercise routine.

Continue to undergo regular lab tests to monitor your liver function. Attend all follow-up appointments to ensure your recovery progresses smoothly. Your provider will work closely with you to maintain your stability and overall health.

Contact your healthcare provider immediately if you experience any worrisome symptoms, such as:

• Fever.
• Chest pain.
• Persistent coughing.
• Difficulty breathing.
• Episodes of fainting.
• Unusual excessive sweating.

These steps will help ensure you receive prompt attention and appropriate care.