Left gastric venous caval direct shunt in esophagogastric varices.

We undertook 10 cases of Inokuchi shunt operation (left gastric venous caval shunt), which is a very logical form of treatment but which is not practiced because of its technical difficulty due to the fragility of the left gastric vein. The technical procedures were modified to include an ablation and anastomosis of the left gastric vein. The difficulty in performing an ablation of the left gastric vein from the lymph node and lymphatic duct was solved by using surgical loupes. The difficulty in performing an anastomosis was solved by dissecting the left gastric vein along with the normal portion of the splenic vein, as in Carrel's patch procedure. Although in this study we used an autograft of the superficial femoral vein, left renal vein, and right hepatic vein in the initial period as well as an original Inokuchi shunt, we also performed direct anastomosis by mobilizing the Spiegel lobe by cutting the ligament of the vena cava inferior. This device shortened the operation time by 2 hours. All patients were discharged without serious complications. All patients were in good condition; however, follow-up periods were not very long. In conclusion, the Inokuchi shunt operation as well as the distal splenorenal shunt were thought to be very useful.