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

Abstract

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.