Cirrhosis: Surgical Shunts for Portal Hypertension

Topic Overview

Shunt surgeries are designed to redirect the flow of blood or abdominal fluid through other areas of the body. Shunts are rarely used because of the complications they may cause. They are done only in medical centers where the surgeon is experienced in doing the procedures.

• Peritoneovenous shunts. These shunts may reduce fluid buildup in the abdominal cavity (ascites) by diverting the fluid into normal blood circulation.
• Portacaval shunts. Portacaval shunts may lower blood pressure in the portal vein by diverting the flow of blood from the portal vein to the large vein that returns blood to the heart (vena cava).

Shunt surgery may be used for people:

• Who have relatively good liver function and serious complications of portal hypertension, especially recurrent variceal bleeding.
• Who are not good liver transplant candidates because of advanced age, continuing alcohol use, or both.
• When other treatments (such as variceal banding for bleeding or diuretics for ascites) have not worked.
• Who have ascites and can't have a transjugular intrahepatic portosystemic shunt (TIPS) or repeated paracenteses.
• Who do not have close access to medical care and cannot quickly return for more variceal banding treatments or paracenteses.

Complications of shunt surgery may include changes in mental function (encephalopathy). People who have large-diameter portacaval shunts have a 30% to 40% rate of encephalopathy.^{footnote 1}