What tests are required before the procedure?

Before the procedure, you will have had the following tests to determine the extent and severity of your portal hypertension condition:

Before the procedure, your physician may ask you to undergo pre-operative tests. The tests can include an electrocardiogram (also called an EKG), chest X-ray or additional blood tests. If your physician thinks you will need additional blood products (such as plasma), they will be ordered at this time.

Before the surgery

You will meet with the nurse clinician and your physician to discuss the steps of the surgery and any questions you may have. Before the surgery, please follow these guidelines:

Eating and drinking

  • DO NOT eat or drink anything after midnight the day of the surgery, or as directed.


  • Discontinue taking beta-blocker medications (such as Inderal®) 48 hours prior to the surgery.
  • Ask your physician if you should take your other daily medications before the surgery.

Note: Do not discontinue any medications without first consulting with your physician.

On the day of the surgery

Please do not bring valuables such as jewelry or credit cards.

A general anesthetic will be given to you before the surgery. The time required to perform the surgery is about four hours.

You will be required to stay in the hospital for approximately seven days after the surgery. Please bring a robe and any other items you would like to make your stay more comfortable.

After the surgery

  • A temporary catheter will be placed in your bladder initialy after surgery to drain urine.
  • A nasogastric tube will be placed through your nose and into your stomach for 24 hours after the surgery. This tube will remove gas or gastric secretions directly from the stomach. Once your digestive system starts working again, your diet will gradually advance and you will be able to eat solid foods.
  • An IV will be inserted in your neck to deliver fluids and medication.
  • Your pain will be managed by a patient-controlled pain pump. This will deliver narcotics directly into your IV on demand (when you decide you need them).
  • Within 7 days after the surgery, you will have an angiogram to determine the effectiveness of the shunt. If the shunt appears to be functioning properly, you will be discharged the following day.
  • A dietitian will explain your nutrition requirements before you go home. You will be asked to follow a low-fat, low-salt diet. You will probably be required to consume no more than two grams of sodium (salt) or 30 grams of fat per day for six to eight weeks after the procedure. The dietitian will explain how to figure these amounts in your diet.

* Note: The therapies and time intervals listed above are typical and may change depending on the expertise of your healthcare provider and your condition.

Last reviewed by a Cleveland Clinic medical professional on 11/06/2017.


  • J. Michael Henderson JM, Boyer TD, Kutner MH, et al. Distal Splenorenal Shunt Versus Transjugular Intrahepatic Portal Systematic Shunt for Variceal Bleeding: A Randomized Trial. Gastroenterology 130(6):1643–51.
  • Jenkins RL, Gedaly R, Pomposelli JJ, et al. Distal splenorenal shunt: role, indications, and utility in the era of liver transplantation. Arch Surg. 1999 Apr;134(4):416-20.
  • Elwood DR, Pomposelli JJ, Pomfret EA, et al. Distal splenorenal shunt: preferred treatment for recurrent variceal hemorrhage in the patient with well-compensated cirrhosis. Arch Surg. 2006 Apr;141(4):385-8.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy