From Big Medical Encyclopedia

SPLENORENALNY ANASTOMOSIS (Greek splen spleen + lat. ren kidney; Greek anastomosis the mouth, an exit) — operation of creation of an anastomosis between splenic and left renal veins.

For the first time in a wedge, the practician S. and. Bleykmor and the Lord imposed in 1945 (And. H. Blakemore, J. W. Lord).

So-called central (proximal) S.'s imposing is most of all widespread and. and anastomosis side sideways. Also the selection S. is applied and. without removal of a spleen.

Indication to operation the varicosity of a gullet at patients with cirrhosis serves in a stage of compensation. Abroad S. and. apply also in emergency situations at already developed bleeding from veins of a gullet. S.'s imposing and. contraindicated at a hepatic decompensation, especially at ascites, jaundice, low albuminoglobulinovy coefficient, etc.

Diagrammatic representation of different types of a splenorenalny anastomosis: and — the central (proximal) splenorenalny anastomosis (the splenic vein is crossed, the anastomosis between its proximal department and a renal vein is imposed, the spleen is removed); — an anastomosis a side sideways; in — a splenorenalny anastomosis by Warren's method (the splenic vein is crossed, its proximal department is tied up, imposed an anastomosis between its distal department and a renal vein); 1 — a spleen; 2 — distal department of a splenic vein; 3 — proximal department of a splenic vein: 4 — a left kidney; 5 — the left renal vein; 6 — a splenorenalny anastomosis; 7 — the lower vena cava; 8 — a liver.

Central S. and. usually impose in position of the patient on the right side with a deviation of a trunk back at an angle 45 — 60 °. The Abdominodiafragmalny or slanting section in left hypochondrium (see. Laparotomy ) open an abdominal cavity. After bandaging of a splenic artery and crossclamping of a splenic vein make splenectomy (see). Would will mobilize a stump of a splenic vein on an extent not less than cm and after a section of a fatty tissue along a vascular leg of a left kidney allocate her vein, in a wall a cut cut the oval opening corresponding to diameter of a splenic vein. Then the stump of a splenic vein is anastomosed with a renal vein (fig., a).

At S.'s performance and. a side sideways with preservation of a spleen it is possible to apply a median laparotomy. Bare a splenic vein, mobilizing bottom edge and a back surface of a pancreas. Then allocate the left renal vein throughout 6 — 7 cm. In walls of both veins cut oval openings 16 — 18 mm long and 6 — 7 mm wide then between them impose an anastomosis (fig., b).

The selection S. and. also it can be carried out by means of a median laparotomy. Impose an anastomosis a side sideways between renal and splenic veins, and then cross a splenic vein proksimalny an anastomosis after bandaging or underrunning by a stapler.

At S.'s imposing and. by Warren's method the splenic vein is crossed, the stump of the proximal end is tied up, and a distal stump anastomose with a renal vein the end sideways with preservation of a spleen (fig., c).

From postoperative complications thrombosis of an anastomosis is possible, the probability to-rogo increases during removal of a spleen. Later complication is development of encephalopathy. According to M. D. Patsior (1974), at the central S. and. symptoms of encephalopathy and a recurrence of bleeding from expanded veins of a gullet arose considerably more often than at the selection S. and.

Bibliography: Patsiora M. D. Surgery of portal hypertensia, page 213, 274, M., 1974; Shalimov A. A. and Shchu with V. A. The side selezenochno-renal shunt with preservation of a natural porto-caval anastomosis at portal hypertensia, Klin, hir., No. 5, page 17, 1966; Martin E. W. and. lake of Observations on fifty distal splenorenal shunts, Surgery, v. 84, p. 379, 1978; Warren W.D., Z e p p a R. a. F about m about n J. J. Selective trans-splenic decompression of gastroesophageal varices by distal splenorenal shunt, Ann. Surg., v. 166, p. 437, 1967; Warren W. D. a. o. Selective distal splenorenal shunt, Arch. Surg., v. 108, p. 306, 1974; W h i p p 1 e A. O. Rationale of portacaval anastomosis, Bull. N. Y. Acad. Med., v. 22, p. 251, 1946; Z e p p a R. o. Survival after distal splenorenal shunt, Surg. Gynec. Obstet., v. 145, p. 12, 1977.

M. D. Patsiora.