Inferior mesenteric vein left renal vein shunt in portal hypertension

No  general   consensus exists  regardiug the  proper   surgical   111nnageme11t  of  recurrent variceal  bleeding  due  to liver cirrl1osis.TI1e inherent small diameter of the iuferior mesenteric Vl!ill cau  be used  for shunting blood  to systemic circulation, not diverting blood completely from  the liver.
The study included 24 patients, 7 females and 17 males with age range behueen 21to 45 years.All patients were class A and B accordi11g to Child  classificatioll allfi had  prior episode of variceal  bleeding  duo  to portal  hypertension.  Preoperative liver functions, upper  GI  endoscopy for  variceal grading, and   presence  of  gastropatlly were  compared wit/1   tl1e postoperative results.
TI1e outcome of this shunt revealed no reb/eeding episodes, improveme11t of variceal gradings, no  postoperative development of ascites or encephalopatl1y in all  patients.There was improvement in liver  functions and endoscopic degree of gastropathy. Ouly one patient developed portosystemic encllalopatlty after  18 monll1s  of  follow 11p. There was no improvement of blood picture  and  splenectomy had  to be done  in  cases  with hypersplenis m. [ar/y shunt patency rate  was 19124 (70.5%)  and 14 shunts were found  patent after 18 mouths of follow up.
In  conclusion, Inferior mesenteric vein   to left renal  veiu   shunt is a  simple procecfure, witlr   small stoma, durable shunt, effective in  portal decompression, and  can be used  as a good  altemtrtive to major shunt procedures or tra11s-intemal jugular portosystemic shunt (TIPS) before liver transplantation.