Portacaval shunting is a major operation, requiring an abdominal incision.

Blood flow is diverted around the liver, usually by creating a connection between the portal vein and the inferior vena cava. This reduces pressure in the veins draining the liver, decreasing the dilation of variceal veins in the esophagus, which otherwise are prone to rupture and bleeding.

Portocaval shunting has largely been abandoned since the advent of TIPS (transjugular intrahepatic portosystemic shunting). This procedure does not involve an incision; rather, a catheter is placed into a large vein in the neck through which a shunt is deployed in the veins draining the liver, thus diverting blood flow around the diseased liver.

Portacaval shunting is generally reserved for patients who have failed TIPS.

Patients with liver disease have a greatly increased risk of complications after surgery, including bleeding, encephalopathy, and liver failure. The risks associated with surgery in such patients are significant. Portacaval shunting is generally a procedure used to prolong life until other measures can be taken. Patients with chronic progressive liver disease who are good candidates should be evaluated for liver transplant

Complications from this procedure include bleeding, worsening of encephalopathy, and liver failure.

Call your doctor if you experience any of the signs of liver disease, including jaundice, changes in mental status, or bleeding.