Abstract
We experienced Inokuchi's shunt operation (left gastric venous caval shunt) in 7 cases with esophago-gastric varices. Although the operation is logically superior, it is not prevailing because of its technical difficulty due to fragile left gastric vein. The difficulty of separation of left gastric vein (LGV) from lymph nodes and lymphatic ducts was solved by the use of surgical loupes. The difficulty of anastomosis between LGV and vena cava was settled by the fixation of LGV to normal portion of splenic vein like Carrel's patch. Although we used autograft, superficial femoral vein, left renal vein, and right hepatic vein in initial period according to the original Inokuchi's shunt, recently we performed direct anastomosis by the mobilization of Spiegel lobe by cutting the ligament of vena cava inferior. This modified method enables shortening an operation time up to 2 h. All patients were discharged without serious complications. The patency was well maintained in all patients, within a short follow-up period. In conclusion, the Inokuchi's shunt operation was estimated to be very useful as well as distal spleno-renal shunt.
