Further Evaluation of Selective Decompression of Varices by Distal Splenorenal Shunt

Wd, Warren; Fomon, John J.; Zeppa, Robert

doi:10.1097/00000658-196905000-00002

Cited by 60 publications

(7 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…20,21 This shunt is designed to provide selective decompression of gastroesophageal venous varices, without significant impairment of hepatic portal venous perfusion, in patients with portal hypertension and hepatic cirrhosis with hemorrhage. The shunt is designed to allow selective decompression of the coronary venous plexus through gastric venous collaterals into the spleen by way of carefully preserve short gastric veins.…”

Section: Discussionmentioning

confidence: 99%

“…21 The effectiveness of distal splenorenal shunt in decompressing esophageal varices is indicated by lack of recurrent upper gastrointestinal bleeding in the follow-up data now available from Warren's series. 20 Distal splenorenal shunt proposed by Warren and associates in 1967. Despite the theoretic advantages of this procedure over total portasystemic shunting; the surgeons have been slow to accept the Warren shunt.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Warren shunt - significance in present time, an experience at tertiary care hospital in India

et al. 2016

View full text Add to dashboard Cite

INTRODUCTIONPortal hypertension is the presence of portal venous pressure more than 10 mm Hg. Esophagogastric varices do not bleed until portal pressure exceeds 12 mm Hg, and then they bleed in only one third to one half of patient. 1Portal hypertension was recognized by the Greeks and was highlighted by Shakespeare in his character of Falstaff.2,3 Surgery was the only treatment available for portal hypertension in the earlier times and the mortality rates were very high. In present times, about 10-15% of patients require surgery. With the development of the endoscopic treatment i.e. sclerotherapy, surgery no longer remains the first line of treatment in portal hypertension.Shunts have been attempted since 1877 wherein Eck ligated the portal vein and connected the visceral end to the vena cava. It commonly became known as Eck Fistula.4 Nicolai Eck was a Russian Army surgeon and performed an end-to-side portocaval shunt in an animal model. Vidal, a French surgeon is credited with performing the first portal systemic shunt in man in 1903. In mid-1940's a portocaval shunt was devised by Whipple and Blakemore and many other procedures were tried as mesocaval shunts by Drapanas, selective variceal decompression by Warren and Inochuchi and partial shunts by Sarfeh. [5][6][7][8][9] First sclerotherapy was done with rigid oesophagoscope. In the 1980s, three surgeons Johnston, Terblanche and Paquet turned from rigid to ABSTRACT Background: Portal hypertension is the presence of portal venous pressure more than 10 mm Hg. Surgery was the only treatment available for portal hypertension in the earlier times and the mortality rates were very high. In present times, about 10-15% of patients require surgery. Here we study the significance of the distal splenorenal shunt (Dean Warren shunt). Methods: We studied a total of 45 patients of portal hypertension admitted at SSKM Hospital, IPGMER, Kolkata, over a period of 5 years. This study includes the patients, ranging in age from 5 to 20 years and comprising of 5 women and 40 men. All patients were having non cirrhotic extra-hepatic portal. Results: All of the patients survived postoperatively and are in follow-up without any complication and doing well. Conclusions: Warren's shunt is a good alternative of liver transplantation, especially for the developing countries where the facilities for liver transplantation and post-operative care are not available or good enough. It has very good results and low complication rates.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Warren shunt - significance in present time, an experience at tertiary care hospital in India

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The outcome of their studies was selective transplenic decompression of varices [1]. Initially the distal splenorenal shunt (DSRS) was shown to be feasible in dogs [1] and was then applied to patients [4]. Over the next 20 years it has become widely used on a worldwide basis [5].…”

mentioning

confidence: 99%

Role of distal splenorenal shunt for long‐term management of variceal bleeding

1994

World j. surg.

View full text Add to dashboard Cite

Distal splenorenal shunt (DSRS) has been studied extensively over the past 25 years to define its role in management of variceal bleeding. The operative technique of the shunt has not changed, but more aggressive attempts at portal-azygos disconnection have been studied for their effect on maintenance of portal perfusion. Control of variceal bleeding is achieved in about 90% of patients. Portal flow to the liver is maintained in > 90% of patients with nonalcoholic etiology of portal hypertension and in 50% to 84% of patients with alcoholic cirrhosis depending on the degree of portal-azygos disconnection. Encephalopathy and liver failure do not seem to be accelerated by DSRS but depend on the severity of the underlying liver disease. Reported survival likewise depends on the etiology of portal hypertension and the severity of liver disease: > 90% survival can be achieved in portal vein thrombosis and patients with cirrhosis and normal liver function, but 50% to 60% 3- to 5-year survivals are reported for patients with more advanced disease. DSRS offers one treatment modality for management of variceal bleeding that must fit into an overall strategy for these patients. Full evaluation is the key to allow selection of patients for pharmacotherapy, sclerotherapy, variceal decompression, or liver transplantation.

show abstract

“…Ein prinzipiell andersartiges Veffahren stellt die distale oder zentrale spleno-renale Anastomose dar [22]. Hier bleibt der Pfortaderhochdruck erhalten, die Verbindungswege zu den Oesophagusvaricen werden durchtrennt und die Varicen selektiv fiber die in die linke Nierenvene implantierte Milzvene selektiv drainiert.…”

unclassified

11. Zur Problematik der operativen Behandlung des Pfortaderhochdruckes bei intrahepatischem Block

Zehle

1976

Langenbecks Arch Chiv

View full text Add to dashboard Cite

Besides the high risk of surgery for bleeding esophageal varices, this therapy can involve an unacceptable rate of late complications following portacaval shunt (PCS). High mortality (liver failure) and morbidity (encephalopathy) can only be diminished by strict selection of patients. Alternative procedures have not yet been proved preferable in the long term. This is also true for the PCS with arterialization of the hepatic part of the portal vein. On the grounds of their own results, the author and his colleagues prefer the distal splenorenal anastomosis (Warren shunt).

show abstract

Further Evaluation of Selective Decompression of Varices by Distal Splenorenal Shunt

Cited by 60 publications

References 7 publications

Warren shunt - significance in present time, an experience at tertiary care hospital in India

Warren shunt - significance in present time, an experience at tertiary care hospital in India

Role of distal splenorenal shunt for long‐term management of variceal bleeding

11. Zur Problematik der operativen Behandlung des Pfortaderhochdruckes bei intrahepatischem Block

Contact Info

Product

Resources

About