Portal-systemic shunt procedures

The use of portal-systemic shunt procedures for the treatment of acutely bleeding oesophageal varices is now reserved for the 5-10% of patients who fail to respond to pharmacotherapy or sclerotherapy.

Portal-systemic shunts have a high intraoperative mortality and a poor 5 year survival, particularly in patients with significant hepatic decompensation. The most common problem is chronic hepatic encephalopathy.

There are two types of portal-systemic shunt procedures:

• non-selective procedures:
  • the whole portal system is decompressed
  • include the end-to-side and the side-to-side porta-caval shunts
  • carry a high risk of hepatic encephalopathy
    
    
• selective procedures:
  • only decompress the oesophagogastric venous network
  • have a lower risk of encephalopathy
  • include the spleno-renal and the left-gastric -inferior venal cava shunts

Transjugular intrahepatic portal-systemic shunting (TIPSS) is a new procedure which is particularly useful in the treatment of acutely bleeding oesophageal varices if liver transplantation is being considered.