The liver is one of the most important organs in our body. But sometimes, damage to the liver can cause serious problems inside the body that we don't notice. One such problem is the increase in pressure in the veins that bring blood to the liver. This high pressure can even cause dangerous bleeding. Today we are talking about a special surgery that can help save lives in such situations. That is the Distal Splenorenal Shunt, or DSRS surgery for short.
What is this 'Portal Hypertension'?
Let's put this simply. Imagine that the main water pipe in your house is blocked. What happens then? The water gets stuck in one place, the pressure increases, and it sometimes starts leaking out from other places. The same thing happens in our bodies.
After the food we eat is digested, the blood that has absorbed those nutrients is carried to the liver through a large blood vessel called the portal vein . If the liver is damaged in some way (for example, due to a condition like cirrhosis), the blood cannot flow easily through this portal vein. It's like a water pipe getting stuck.
When blood flow is obstructed in this way, the pressure inside the portal vein increases excessively. We call this 'Portal Hypertension' .
Because of this high pressure, the blood starts to find other routes. These new blood vessels (we call them varices ) often form in the stomach or esophagus. These are very weak, thin-walled veins. When the pressure increases further, they swell, burst, and start to bleed. This is a dangerous condition that requires emergency medical treatment.
So what does this DSRS surgery do?
DSRS surgery is, to put it simply, a new 'bypass' for the blocked blood flow. This surgery involves diverting some blood from the high-pressure portal vein system and redirecting it to a lower-pressure area.
Here's how to do this:
The surgeon carefully separates the splenic vein from the portal vein, which is under high pressure. Then, the vein is connected to the renal vein in your left kidney. The renal vein is a low-pressure, well-circumscribed vein.
Simply put, it's like taking some vehicles off a busy road and redirecting them to a less congested road. This reduces the pressure in the portal vein, which can help control the risk of dangerous bleeding.
When is DSRS surgery necessary?
After your doctor has performed various tests, he or she may recommend this surgery if the varicose veins in your esophagus or stomach are swollen or bleeding. In addition, this surgery can also help control other complications caused by portal hypertension.
| Complication | Simple explanation |
|---|---|
| Bleeding with vomiting or stool | It can be caused by the rupture of weak blood vessels (varices). |
| Fluid accumulation in the abdomen (Ascites) | Fluid leaking from blood vessels into the abdominal cavity due to high pressure. It feels like the stomach is full. |
| Leg swelling (Edema) | Swelling of the legs and feet due to changes in the body's fluid balance. |
| Enlarged spleen (Hypersplenism) | The spleen becomes enlarged due to blood clots. |
| Kidney failure and memory loss | Other serious complications that can occur due to impaired liver function. |
What is the difference between DSRS and other types of shunts?
There are several types of shunts used to reduce pressure in the portal vein. The main goal of all of these is to control bleeding.
- Distal Splenorenal Shunt (DSRS): This is the surgery we are talking about now. In this, an open surgery is performed and a bypass is created using a vein that is already in the body.
- Transjugular Intrahepatic Portosystemic Shunt (TIPS): This is a little different from DSRS. It doesn't involve major surgery. Instead, a thin tube, like a catheter, is inserted through a vein in the neck and connects the portal vein to the main vein that leaves the liver (hepatic vein) from within the liver. This is the most commonly used method today.
Your medical team will decide which method is best for you.
What to expect before surgery?
Before scheduling your surgery, your doctor will take your complete medical history and perform a physical exam. They may also order several tests to assess your overall health, liver function, and the severity of your portal hypertension.
This may include:
- Blood tests
- Liver function tests
- Chest X-ray
- EKG test
- Angiogram - to look at the condition of the blood vessels
- Upper endoscopy - to look inside the esophagus and stomach
The medical team will give you clear instructions on how to prepare for surgery. For example, they will tell you what medications to stop taking, what to bring to the hospital, and when to stop eating and drinking. Ask them about any questions or concerns you may have at this time.
How is the surgery done?
The DSRS surgery usually takes about four hours. First, you are put under general anesthesia. So you are asleep throughout the surgery and do not feel any pain. The surgical team, as we discussed earlier, carefully removes the splenic vein and connects it to the renal vein.
What happens after the 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 inserted to drain urine.
- A nasogastric tube (NG tube) is inserted for about 24 hours to remove air and fluid from the stomach.
- A saline (IV) line is connected to a vein in the neck to administer medications 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 new shunt is working properly. When you are able to eat, you will be gradually introduced to liquids and 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.
When should you seek immediate medical advice?
After you go home, you should take great care of your recovery. If you develop any of the following symptoms, call your doctor immediately or go to the Emergency Department (ETU) of your nearest hospital.
- Cough
- Difficulty breathing
- To cast a spell
- Fever
- Chest pain
- Sweating more than usual
It's normal to feel a little nervous and anxious about undergoing this type of surgery. But remember, DSRS is a very effective way to protect yourself from the dangerous complications of portal hypertension.
Take-Home Message
- DSRS is a surgery that treats portal hypertension, a complication of liver disease.
- This is mainly used to control bleeding that could be life-threatening.
- This is a fairly major surgery, and you will have to stay in the hospital for several days afterward.
- It is very important to follow the doctor's and nutritionist's instructions exactly for a speedy recovery after surgery.
- If any emergency symptoms arise, seek medical advice without delay.
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