Comparison between selective distal splenorenal shunt and small diameter H-graft portosystemic shunt.

Although most commonly performed portal decompressive procedures control bleeding effectively, postoperative morbidity and mortality remains a serious problem in these patients. Both distal splenorenal shunts (DSRS) and small-diameter portacaval H-grafts (PCHG) are reported to produce decreased rates of postoperative encephalopathy. We prospectively evaluated 69 patients in whom 27 PCHG and 45 DSRS were performed over a seven-year interval. There were no significant preoperative differences between these groups. Operative mortality was 12.9% overall. DSRS was associated with decreased intraoperative blood transfusions and operative time. Postoperatively, DSRS was associated with significantly less encephalopathy, other postoperative complications, and ascites. Recurrent variceal bleeding was seen in three patients treated with PCHG and two patients with DSRS. We conclude that both DSRS and PCHG are effective in preventing recurrent variceal bleeding, but DSRS remains our procedure of choice because of its decreased rates of postoperative complications.