A nonselective proximal end-to-side shunt between the gastric vein and the inferior vena cava (coronario-caval shunt). Indication, technic and results

From 1976 to 1982, 104 patients with bleeding esophageal varices were treated surgically. In three patients a wide left gastric vein without portal flow was demonstrated by means of arterial splenoportography. Ascites estimated between 4 to 61 was observed in two patients. Anemia, leukopenia, platelet counts inferior to 85 X 10(9)/l were shown in all of them. Liver panangiography was done in the three patients. According to the absence of portal flow, the presence of intractable ascites and the demonstration of a wide left gastric vein, we dissect this vein disconnecting it from the stomach, and performing the anastomosis between the proximal end of this vessel and the inferior caval vena (proximal unselective left gastric caval shunt). Ascites and esophageal varices disappeared in the three patients between 1 and 3 weeks after the operation. The shunts were confirmed open between eight months to eight and a half years after operation. All the three patients are still living.