Your liver is a very important organ in our body. But due to some diseases , especially when the liver is damaged , the pressure in the blood vessels connected to it can increase excessively. This can lead to dangerous situations like sudden vomiting of blood. Today we are talking about a special surgery that is performed to save lives in such cases. This is called DSRS surgery.
What is Distal Splenorenal Shunt (DSRS)?
Simply put, Distal Splenorenal Shunt (DSRS ) is a surgical procedure that relieves pressure in your portal vein. Now you may be wondering what the portal vein is. The portal vein is the main blood vessel that carries blood from the digestive tract ( stomach , intestines, etc.) to the liver.
Some medical conditions cause the pressure in this vein to increase too much. We call it Portal Hypertension . Surgeons use this DSRS procedure to control bleeding and other complications caused by this high pressure.
The important thing is that DSRS surgery cannot cure the underlying cause of Portal Hypertension. However, it can help manage the dangerous symptoms that arise. After this surgery, you will need to continue to have tests and follow-up with your doctor to monitor your condition.
First, let's understand what Portal Hypertension is?
Portal Hypertension, as we mentioned earlier, is high blood pressure in the portal vein. The main cause of this is damage to the liver. For example, a condition like cirrhosis can cause the liver to become stiff, obstructing the flow of blood through it.
Imagine what happens if a water pipe gets blocked in the middle. The pressure inside the pipe increases, and the water tries to escape from other places, right? Similarly, when blood can't pass through the liver, the pressure in the portal vein increases.
Because of this high pressure, blood starts to find other ways to flow. These new, weak-walled blood vessels are what we call 'varices' . These mainly form in your esophagus and stomach.
As the pressure increases, these varices swell, their walls thin and weaken. They can leak fluid into the abdomen (this is called ascites ), and the most dangerous thing is that they can burst and start bleeding. This is a medical emergency.
What exactly happens during DSRS surgery?
DSRS surgery works by diverting the excessive blood flow in the portal vein and reducing its pressure. This is similar to building a new bypass road to relieve heavy traffic in a city.
During this operation, the surgeon will do the following:
1. The splenic vein of your spleen is separated from the portal vein.
2. Then the separated splenic vein is connected to the renal vein of your left kidney.
By creating a new path for blood to flow in this way, the pressure in the portal vein is reduced, the swelling of the varices is reduced, and the surgery is designed to ensure that the liver continues to receive the blood supply it needs.
Who needs DSRS surgery?
This surgery may be recommended if your doctor determines that your esophageal or gastric veins (varices) are enlarged or bleeding. It can also be a solution to other complications caused by Portal Hypertension.
The table below can explain this further.
| Symptom/condition | Simple explanation |
|---|---|
| Bleeding with vomiting or stool | This is a key symptom of varicose veins bursting. |
| Gastrointestinal bleeding | The above situation is explained in another way. |
| Ascites | Fluid leaking from blood vessels into the abdominal cavity due to high pressure. |
| Swelling of the legs and feet (Edema) | It can be caused by changes in the body's fluid balance. |
| Enlarged spleen (Hypersplenism) | The spleen becomes enlarged due to the increased amount of blood flowing into it. |
| Kidney failure | Impaired liver function can also affect the kidneys. |
| Mild Cognitive Impairment | Toxins that should be removed from the liver accumulate in the blood and affect the brain. |
What is the difference between DSRS and other shunt treatments?
The common goal of all shunt treatments for portal hypertension is to reduce pressure in the portal vein and control bleeding. However, there are differences in how these are done.
- Transjugular Intrahepatic Portosystemic Shunt (TIPS): This is not a surgical procedure. It involves inserting a catheter-like tube through a vein in the neck and creating a connection between the portal vein and the hepatic vein inside the liver. This TIPS procedure is more common than DSRS these days.
- Proximal splenorenal shunt: This is also a surgical procedure. However, it may require the removal of the spleen itself.
- Spontaneous splenorenal shunt (SSRS): This is not a surgical procedure. It is a connection that the body naturally forms when liver disease is very severe. This indicates that the disease is very advanced.
What to expect before surgery?
Your doctor will first ask about your medical history and examine you. Then, they will perform several tests to determine your general health, liver function, and the severity of your portal hypertension.
These tests may include:
- Blood tests
- Liver function tests
- Chest X-ray
- ECG (Electrocardiogram)
- Angiogram - This is a special test that looks at the condition of the blood vessels.
- Upper endoscopy - examination of the inside of the esophagus and stomach using a tube with a camera
Your medical team will give you a clear set of instructions before surgery.
- What medications should be stopped before surgery?
- What things should I bring when I come to the hospital?
- The exact time to stop eating and drinking before surgery.
Ask the doctor any questions or concerns you have about this and have them explained thoroughly. Don't keep anything to yourself.
What happens during the surgery?
DSRS surgery usually takes about four hours . First, you are given general anesthesia. This means you don't feel any pain and are completely asleep.
Then the surgical team, as we discussed earlier:
1. The splenic vein is separated from the portal vein.
2. Take that vein and connect it to the renal vein of the left kidney.
What should I expect after surgery?
After the surgery, you will need to stay in the hospital for about a week or ten days . During this time, the medical team will take good care of you.
- A temporary catheter is placed to drain urine.
- A nasogastric tube is placed through the nose for about 24 hours to remove air and fluids from the stomach.
- An IV will be placed in a vein in your neck to give you medication and fluids.
- You will be given a self-administered pain pump to control the pain.
About a week after surgery, you will have another angiogram to check that the shunt is working properly. When you are able to eat and drink, you will be given liquids first, then solids. Before you go home, a dietitian will meet with you to discuss a diet that is right for you. A low-salt, low-fat diet is often recommended.
Are there any risks to this surgery?
Like any surgery, there are some risks, but DSRS is generally a very safe and successful procedure.
The risk of bleeding again is higher in the first month after surgery. But don't worry. Your medical team will help you manage this risk and keep you well informed about it.
What should you do during your recovery after going home?
It is very important to follow the instructions given by your doctor and nutritionist carefully for a speedy recovery. Ask your doctor when you can resume normal activities and exercise.
You will need to have regular blood tests to check how your liver is functioning. Never miss your follow-up appointments. Your doctor will continue to monitor your condition and give you the advice you need to stay healthy.
What are the symptoms that require immediate medical attention?
If you experience any of the following symptoms, it could be a sign of a serious condition. Therefore , go to a hospital's Emergency Department (ETU) immediately or call the 1990 ambulance service.
- Cough
- Difficulty breathing
- To cast a spell
- Fever
- Chest pain
- Sweating more than usual
It's normal to feel scared and anxious when you learn that you have a condition like Portal Hypertension. But your doctor will sit down with you, monitor your symptoms, and help you manage them. If necessary, surgery like DSRS can help control your risk of bleeding and help you live a better life.
Take-Home Message
- DSRS is a surgery performed to reduce high pressure in the portal vein (blood vessels leading to the liver).
- The main goal of this is to control dangerous complications such as bleeding caused by Portal Hypertension.
- This surgery does not cure liver disease, but it can greatly help manage symptoms.
- It is very important to follow the doctor's instructions after surgery, especially diet and going to clinics on time.
- If you experience symptoms such as difficulty breathing, chest pain, or excessive sweating, seek medical advice immediately.
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