Warren shunt

Warren Shunt is a surgical procedure used in the treatment of portal hypertension, a condition characterized by increased blood pressure within the portal vein system. This medical intervention is named after Dr. J. Michael Warren, who was instrumental in its development. The Warren shunt, also known as the distal splenorenal shunt (DSRS), is specifically designed to alleviate portal hypertension by redirecting blood flow from the spleen and parts of the stomach to the left renal vein. This procedure is considered when other treatments have failed and is aimed at reducing the risk of complications such as variceal bleeding, which is a life-threatening condition.

Procedure

The Warren shunt involves the surgical creation of a connection between the splenic vein and the left renal vein. By doing so, it selectively decompresses varices in the stomach and esophagus that are prone to bleeding, while maintaining the pressure in the portal vein to support liver function. This selective approach helps in preserving the filtration function of the liver, which can be compromised in non-selective shunting procedures.

Indications

The primary indication for a Warren shunt is significant portal hypertension leading to recurrent variceal hemorrhage that is not manageable by endoscopic or pharmacologic therapies. It is particularly considered in patients who have preserved liver function, as the procedure can help in preventing further bleeding episodes without significantly compromising liver health.

Risks and Complications

As with any surgical procedure, the Warren shunt carries risks and potential complications. These may include:

• Infection
• Bleeding
• Shunt thrombosis or blockage
• Deterioration in liver function
• Hepatic encephalopathy, a condition caused by the buildup of toxins in the brain due to impaired liver function

Outcomes

The Warren shunt has been shown to be effective in reducing the risk of rebleeding from varices. However, it does not improve survival rates when compared to other treatments for portal hypertension. The success of the procedure largely depends on the patient's overall liver function and the ability to manage potential complications.

See Also

• Portal hypertension
• Variceal bleeding
• Liver cirrhosis
• Splenorenal shunt

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