The failure of portal shunts to enhance survival reflected the associated complications of encephalopathy and post shunt failure. This operation was devised to preserve the flow of blood through the portal vein to the liver while decompressing varices in the stomach and oesophagus by joining the splenic vein to the left kidney vein. Studies comparing portal systematic shunts with DSRS found similar rates of overall mortality and cumulative survival. DSRS had a higher operative mortality but a lower rate of encephalopathy afterwards. Also, patients with alcoholic cirrhosis do poorly with DSRS compared to nonalcoholic cirrhotic patients.
Endoscopic therapy is a way or reducing variceal bleeding without surgery.
Another technique called variceal banding, involves placing rubber bans around the veins through the endoscope. The major merit or endoscopic therapy is that it is relatively easy to apply and can be administered at many primary care hospitals. It is commonly used in the initial management of patients with cirrhosis and variceal bleeding. In this combination, initial endoscopic therapy and selective shunt surgery may significantly improve survival in patients with variceal bleeding. TIPS is performed by radiologists using only a local anaesthetic and a sedative.