Surgical splenorenal shunt

Last revised by Calum Worsley on 30 Apr 2023

Surgical splenorenal shunts are anastomoses created between the splenic vein and the left renal vein, performed to ameliorate portal hypertension typically in the context of variceal bleeding.

Surgical splenorenal shunts are not to be confused with spontaneous splenorenal shunts, which form as a collateral pathway in response to chronic portal hypertension.

The classical procedure involves a splenectomy and the end-to-side anastomosis of the splenic vein to the adjacent left renal vein, but the anastomosis can also be carried out side-to-side without splenectomy 1.

The procedure is typically carried out in the context of uncontrolled variceal hemorrhage, so there is substantial associated morbidity and mortality. The procedure has largely been superseded in modern practice by the transjugular intrahepatic portosystemic shunt (TIPSS), though it may still be performed if TIPSS has failed or is not possible 2.

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