Selective vs total portosystemic shunts in the treatment of variceal hemorrhage in cirrhotic patients: is there any advantage?

With the development of sclerotherapy, transjugular intrahepatic portasystemic shunting and liver transplantation, the role of surgically-constructed portacaval shunts in the treatment of variceal hemorrhage is in evolution. Further, when these shunts are indicated, there is controversy as to the appropriate shunt type that should be created. A selective portosystemic shunt (distal splenorenal shunt) has an advantage of having a decreased encephalopathy rate without an increase in shunt thrombosis and rebleeding compared to total portosystemic shunts. There are currently no reports comparing the partially selective H-graft shunt with the distal splenorenal shunt.