End renal vein-to-splenic vein shunts for total or selective portal decompression

An end of renal vein-to-side (or end) of splenic vein shunt has been accomplished in ten patients with satisfying clinical and physiologic results. The total (or functional side-to-side) shunt appears to be easier to perform than a side-to-side splenorenal shunt in many instances. The total renosplenic shunt does not preserve superior mesenteric and portal venous flow to the liver. It has the great advantage, however, of being easily converted to a selective shunt if this should later become desirable. The selective renosplenic shunt (or functional selective distal splenorenal shunt) can be achieved with a renosplenic anastomosis by simply ligating the splenic vein between the anastomosis and the superior mesenteric vein. The much desired features of the selective operation, namely, the decompression of esophageal varices through a widely patent splenorenal shunt, with continued perfusion of the liver by superior mesenteric and portal venous blood, have been documented. Function of the left kidney is altered remarkably little with division of the left renal vein central to the gonadal tributary. Even with sacrifice of the gonadal vein and division of the left renal vein at or near its bifurcation, the depression of renal function was mild to moderate, as judged by the techniques utilized in this study.