Objectives: This prospective, controlled randomized study was designed to compare distal splenorenal shunt (DSRS) 
and 8-mm diameter portocaval shunt (Sarfeh) with extensive collateral ligation (PCS-CL) in the elective management of 
Child-Pugh class A and B schistosomal variceal bleeders. 
Subjects and Methods: Thirty-six patients had DSRS and 38 had PCS-CL. Both groups were similar preoperatively regarding their clinical, biochemical, endoscopic and hemodynamic profiles. Patients were re-evaluated at two weeks and one year after surgery. Mean follow-up was 38.6 months. 
Results: DSRS had a significantly higher operative index than PCL-CL (5.08 ±2.33 vs 1.57±0.74). No differences were observed regarding operative mortality (2.77% vs 2.63%), morbidity including ascites and encephalopathy, and survival (91.6% vs 92.1%). Rebleeding occurred more frequently after PCS-CL (15.79%) compared to DSRS (11.11%). At one year postoperatively, DSRS resulted in complete eradication of gastric varices and significant reduction of esophageal variceal size more than PCS-CL (P<0.05). Splenic size was significantly reduced after DSRS but not after PCS-CL (P<0.05). Colored duplex showed that both procedures significantly reduced portal vein flow volume and diameter, and maintained hepatopetal portal perfusion in all patients. 
Conclusions: In the schistosomal population (1) Both DSRS and PCS-CL have low operative mortality and morbidity, 
(2) Both procedures maintain portal perfusion, have good long-term patient survival, and very low incidence encephalopathy, (3) DSRS is superior regarding variceal eradication, reduction of the rate of re-bleeding, and decrease of splenic size, and (4) PCS-CL is a good alternative if DSRS were not feasible.