Experience with a left gastric venacaval shunt for esophageal varices

A left gastric venacaval shunt for esophageal varices was performed in six patients in attempts to selectively decrease left gastric venous pressure without decreasing portal venous pressure. The left gastric venous pressure decreased from 140–390 mmH₂O to 140–200 mmH₂O after the left gastric venacaval shunt, while the portal venous pressure remained at 140–370 mmH₂O, postoperatively. Even when the portal venous pressure increased up to 320–400 mmH₂O with a temporary occlusion of the portal vein, there were no significant changes in the left gastric venous pressure. Five patients are doing well, one to 36 months postoperatively. One patient died of hepatic failure with bleeding on the 21 st postoperative day. The left gastric venacaval shunt decreased the incidence of rebleeding and prevented postoperative hepatoencephalopathy and hepatic failure.