Background: DSRS is a "selective" shunt used to treat bleeding complications of portal hypertension and has the advantage of long-term patency, low rebleeding and encephalopathy rates. "Non-selective" shunts including transjugular intrahepatic portocaval shunt (TIPS) work well to treat bleeding and ascites but are associated with high rates of encephalopathy. The purpose of this study was to determine the clinical outcome after DSRS for recurrent variceal bleeding. Methods: 42 patients with well-compensated cirrhosis who underwent DSRS between 9/1999 and 11/2012 were studied. Main outcome measures included patient demographics, diagnosis, DSRS indication, hosptial length of stay (LOS), operative (30 day) mortality and morbidity rates, patient survival and shunt patency rates. Results: 29 men and 13 woman (54.2±1.7 years), with end-stage liver disease (Child's A 80%, B 20%) underwent DSRS with hospital LOS of 9±0.9 days. 6 patients (14.3%) had failed TIPS prior to DSRS. The most common cause of cirrhosis was alcohol (36.6%) and HCV infection (29.3%). Operative mortality was 4.7% and morbidity 41.7% with one-year survival of 90.1%. Recurrent variceal bleeding was observed in 2.4%, hepatic encephalopathy in 4.8% and ascites in 14.6%. Overall DSRS shunt patency was 97.6%. Two patients underwent uneventful subsequent orthotopic liver transplantation 4 and 5 years after DSRS respectively. Multivariate logistic regression analysis demonstrated that the presence of preoperative ascites was a significant risk factor (p=0.03) for postoperative mortality with Odd's ratio and 95% confidence interval of 13.09 (1.24-137.95).

Conclusions: DSRS is a safe and effective treatment for recurrent variceal bleeding in well-compensated cirrhotic patients. Low operative mortality, acceptable morbidity and excellent patency rates can be expected in selected patients. Since the hilum of the liver is avoided (unlike other types of decompressive shunts) subsequent liver transplant outcome is unaffected. Well-compensated cirrhotic patients with recurrent variceal bleeding may derive more benefit from DSRS rather than TIPS or ongoing medical therapy.

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