# A Window Opens and a Shunt Closes: A New Laparoscopic Approach for the Attenuation of the Gastrophrenic Shunt

## TL;DR

This paper introduces a new laparoscopic method to treat a type of abnormal blood vessel in dogs, using a device called an ameroid constrictor.

## Contribution

The study presents the first fully laparoscopic use of an ameroid constrictor for shunt attenuation in veterinary medicine.

## Key findings

- The laparoscopic technique successfully occluded the gastrophrenic shunt in a canine patient.
- The procedure was confirmed effective five weeks post-surgery with no flow in the anomalous vessel.
- The method offers a minimally invasive alternative to traditional surgical approaches.

## Abstract

A portosystemic shunt is an anomalous vessel that connects the portal circulation to the systemic circulation, reducing the flow of blood drained from the gastrointestinal system to the liver and generating significant clinical implications. Treatment consists of gradual occlusion of the shunt, aiming at the restoration of liver function and resolution of the clinical signs presented. The ameroid constrictor (AC) is widely used for this purpose; however, to date, there are no reports of its laparoscopic application. This study demonstrates the feasibility of the totally laparoscopic application of an AC associated with intracorporeal sutures in a canine affected by a gastrophrenic shunt.

The portosystemic shunt is characterized by the presence of an anomalous vessel, whether congenital or acquired, that connects the portal circulation to the systemic circulation. Surgical treatment is indicated in congenital cases and involves the progressive occlusion of the anomalous vessel. The objective of this study is to report the use of an innovative and fully laparoscopic technique for the attenuation of a gastrophrenic shunt. The procedure was performed on a two-year-old female German Spitz dog with a history of frequent vomiting and diarrhea. The diagnosis was established through computed tomography. For the procedure, three portals were placed in the left lateral region, employing an ameroid constrictor. This device featured a specific perforation for the passage of a pre-mounted suture, which was subsequently occluded intracorporeally, facilitating the closure of the ring defect. The absence of flow in the anomalous vessel was confirmed five weeks after the procedure. It is concluded that the reported implantation technique represents a new modality for the treatment of this type of shunt using a minimally invasive approach.