Splenorenal Anastomosis

Splenorenal Anastomosis is a surgical connection performed to join the splenic vein to the left renal vein for treating portal hypertension.

June 3, 2022

Splenorenal Anastomosis is a surgical connection performed to join the splenic vein to the left renal vein for treating portal hypertension.

Some facts about Splenorenal Anastomosis:

  • The portal blood flow directly into the systemic venous circulation will be shunt by Splenorenal Anastomosis. 
  • Splenorenal Anastomosis can also be performed in portal vein thrombos.
  • Less patients suffer from hepatic failure or encephalopathy as portal blood supply to the liver is partially maintained after splenorenal anastomosis

Preparation for Splenorenal Anastomosis:

  • Quit smoking a few weeks before the surgery, make sure all other health conditions are well-managed before surgery, inform your doctor about any other supplements, prescriptions, and over-the-counter medications you are taking and about any possibility of pregnancy, if it is a scheduled surgery.
  • Any history of bleeding disorders or are taking any blood-thinning (anticoagulant) medicines, aspirin, or other medicines that affect blood clotting should be informed to your healthcare provider as you may need to stop taking these medicines before your surgery.

Procedure for Splenorenal Anastomosis:

  • A left thoracoabdominal incision will be made in the conventional Linton's splenorenal shunt procedure.
  • The splenic vein is dissected at the splenic porta before the spleen is removed so that the maximum length of the vein is available.
  • The surgeon can determine where in its course the splenic vein lies closest to the renal vein by isolating  the left renal vein.
  • The portion of the splenic vein lying on the posterior aspect of the pancreas will be dissected. 
  • The small pancreatic branches draining into the splenic vein will be isolated and ligated individually.
  • An end-to-side splenorenal anastomosis is performed once an optimal length of splenic vein has been obtained.
  • The patient is placed in a supine position on the operating table in another simplified technique for splenorenal shunt.
  • A long, left subcostal incision will be made and is carried into the left flank and is extended across the midline.
  • The right rectus sheath is partially divided, and the rectus muscle is retracted so that splenectomy is performed. 
  • The fusion fascia of Toldt will be dissected from the tail to the middle of the body of the pancreas by holding the pancreas by its tail, along with the bundle of vessels attached to it.
  • A rapid and easy dissection is permitted by the avascular nature of the fusion fascia.
  • The splenic vein is isolated from the pancreas.
  • Optimal segment of splenic vein is obtained easily after the fusion fascia has been dissected and a long segment of splenic vein will be exposed by this dissection that clearly adheres to the back of the pancreas.
  • Multiple small, tender pancreatic branches of the splenic vein are carefully isolated, ligated, and divided.
  • Bleeding can be avoided by taking such care, which can be profuse due to the high pressure in the splenic vein. 
  • The bleeding resulting from any proximal vascular injury can be controlled easily by applying manual pressure or by using vascular clamps distall as the blood flows away from the liver in patients with portal hypertension.
  • An important advantage of this simplified technique is complete vascular control of the splenic vein.
  • A tension-free, end-to-side splenorenal anastomosis can be constructed as an optimal segment of the splenic vein is easily isolated and approximated to the left renal vein for the next step.
  • The length of splenic vein should be kept short as longer segments are predisposed to kinking, which can cause the shunt to fail.