Distal splenorenal shunt (DSRS) is a surgery to ease pressure in your portal vein, which carries blood from your digestive system to your liver. Surgeons use this procedure to control severe complications of high blood pressure and liver disease.
Distal splenorenal shunt (DSRS) is surgery to ease pressure in your portal vein. The portal vein brings blood from your digestive system to your liver. Surgeons use DSRS to control bleeding and other complications of portal hypertension.
While DSRS can’t cure portal hypertension, it can often help manage symptoms. You typically need regular testing and follow-up care after DSRS to check how you’re doing and help you stay healthy.
Portal hypertension is high blood pressure that happens when your portal vein becomes narrowed or blocked, most often due to liver damage. High pressure forces blood out of your portal vein and into large new blood vessels (varices) that form within your stomach or esophagus.
As pressure builds, varices swell, and their thin walls grow weaker. They may leak fluid into your belly (abdomen), causing discomfort. They may also burst and bleed, which is a medical emergency.
Distal splenorenal shunt helps prevent or control bleeding by moving (diverting) blood flow away from your portal vein. This relieves pressure and eases swelling while making sure that blood continues flowing to your liver.
During DSRS, your surgeon disconnects the vein of your spleen (splenic vein) from your portal vein. Your surgeon then attaches the splenic vein to the vein of your left kidney (renal vein), creating a new path for blood to flow freely.
Your healthcare provider may recommend DSRS if testing shows you have enlarged or bleeding veins in your stomach or esophagus. Other complications of portal hypertension include fluid buildup in your abdomen (ascites) or swelling in your legs and feet (edema).
Portal hypertension may also cause you to have:
The common goal of splenorenal shunt treatment is to ease pressure in your portal vein and control bleeding. DSRS uses surgery to create a path for blood flow (shunt) using an existing vein. Another procedure, transjugular intrahepatic portosystemic shunt (TIPS) uses a minimally invasive (catheter-based) technique to connect your portal vein directly into the vein that carries blood from your liver to your heart (hepatic vein). Overall, TIPS is more common than DSRS.
Two other splenorenal shunts are:
Your provider typically asks about your medical history and does a physical exam. You also receive tests to check your overall health, how well your liver works and the severity of the portal hypertension.
Tests may include:
Your care team gives you instructions about how to prepare for DSRS, including:
Talk to your provider about your questions or concerns so you feel comfortable and ready.
DSRS typically takes about four hours. First, you receive general anesthesia. You’re asleep during the procedure and don’t feel any pain. Then your surgical care team:
You typically recover in the hospital for about a week to 10 days. Your care team:
Within a week after surgery, you have an angiogram to see if your shunt works properly. You receive solid foods and liquids when you’re able to eat and drink. A dietitian also meets with you before you return home. Your dietitian may recommend a low-sodium, low-fat diet.
Distal splenorenal shunt is generally a safe and effective procedure. In the first month after surgery, you face the highest risk of bleeding again. Your team will work with you to help manage your risk and keep you safe.
To optimize your recovery, follow the recommendations of your provider and dietitian. Talk to your provider about when you can return to your routine and physical activity.
You continue to have lab tests to check how well your liver is working. Keep your follow-up appointments, so your provider can make sure you are recovering well. Your provider works with you to keep you stable and healthy.
Contact your healthcare provider or call 911 if you experience concerning symptoms, like:
A note from Cleveland Clinic
You may feel anxious knowing that you have portal hypertension and face the potential risk of serious complications. Your healthcare provider will work closely with you to monitor any symptoms. At some point, your provider may recommend distal splenorenal shunt if tests find swelling or bleeding, or if you have concerning symptoms. DSRS is a safe, effective treatment that can restore your blood flow and help you feel better overall.
Last reviewed by a Cleveland Clinic medical professional on 10/16/2023.
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