Cirrhosis: Surgical Shunts for Portal Hypertension

Surgery Overview

Shunt surgeries are designed to redirect the flow of blood or belly fluid through other areas of the body. Types of shunts used include:

Peritoneovenous shunts.

These shunts may reduce fluid buildup in the belly (ascites). They divert the fluid into normal blood circulation.

Portacaval shunts.

These shunts may lower blood pressure in the vein that carries blood to the liver (portal vein). They do this by diverting the flow of blood from the portal vein to the large vein that returns blood to the heart (vena cava).

Why It Is Done

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.

Shunt surgery may be used for people who:

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

Risks

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