Publication Details
Abstract
The aim of the present study was to assess and compare proximal and distal splenorenal portocaval anastomoses with respect to their impact on hepatoportal hemodynamics in patients with liver cirrhosis presenting portal hypertension. PATIENTS Between December 1998 and June 2001, a prospective clinical study was performed on 36 patients with intrahepatic portal hypertension caused by liver cirrhosis. The patients were classified into two groups: 22 were treated with proximal splenorenal anastomosis and splenectomy, and 14 by distal spleno-renal anastomosis preservation of the spleen together with ligature of the left gastric and the arteries to the spleen plus hepatic artery desympathization. Hepatoportal hemodynamics were evaluated before and after 20 days of surgery by means of splenomanometry, radioisotopic hepatic blood flow determination with Au-198, and rheohepatography. Proximal splenorenal anastomosis significantly reduced the portal pressure; but development of hypoperfusion of the liver and apparent decrease in rheohepatographic parameters were confirmed. DSRA gave selective relief of gastroesophageal venous system pressure, restored mesenteric blood to the liver and achieved better hepatic perfusion indices. This study offers a critical evaluation of hepatoportal hemodynamics following two variations of the splenorenal shunt and illustrates physiologic factors in favor of a selective distal shunting. The data reinforce applying distal splenorenal anastomosis in portal hypertension to limit postoperative hepatic insufficiency and encephalopathy. The number of cases is still too small for the postoperative course and long-term follow-up.