Open Surgical Approach to Intrahepatic Portosystemic Shunts

Introduction
Intrahepatic congenital portosystemic shunts (IHCPSS) can be divided into three broad categories based on morphology: left divisional, central divisional and right divisional, according to which hepatic lobar division they reside in. Left divisional, which are presumed to be the true patent ductus venosus, are arguably the most easy to access surgically whereas, central divisional and right divisional shunts represent more of a surgical challenge. Because of the difficulty associated with the intrahepatic dissection required along with the morbidity and relatively high mortality reported following this, many different techniques have been described to facilitate more accurate and safe surgical treatment of these vascular anomalies; or to obviate the need for surgery altogether.

The perfect treatment for any portosystemic shunt patient would be safe for the patient and result in: 1. the development of a normal intrahepatic portal vasculature, 2. the complete permanent occlusion the shunting vessel without the development of acquired shunts, and 3. normal hepatic function. Unfortunately, it remains unclear with many of the techniques that have been described how frequently this “perfect” outcome is achieved and if it cannot be achieved, it often remains unclear whether this is a fault of the technique used or whether it is because of an inherent feature of this disease process in some affected animals. In addition, all of the techniques described have a “complication rate”, that is, none are 100% safe and predictable.  [...]