Exclusion of Nonisolated Splenic Vein in Distal Splenorenal Shunt for Prevention of Portal Malcirculation

Publisher Website
Google Scholar
Abstract
In an attempt to prevent portoprivial malcirculation after distal splenorenal shunt (DSRS), a splenic hilar renal shunt (HRS) with proximal flush ligation of splenic vein was designed. To accomplish this procedure, 2 methods were compared: HRS alone (group A) and HRS plus proximal flush ligation of the splenic vein (group B) In group A, which included 20 cirrhotic patients with esophageal varices, angiographic as well as pulsed Doppler flowmetric follow-up study revealed a portal thrombosis in 2 patients and severe narrowing of a portal vein in another 2. Considerable stealing flow was observed in these 4 patients. In the group B series, which included 33 cirrhotic patients, there were no gross changes in the portal hemodynamics. Normal prograde portal flow was confirmed by Doppler flowmeter in this series including 14 patients of more than 8 mo. after surgery. When the amount of nonisolated splenic vein embedded in the pancreas is minimized, portal malcirculation after distal splenorenal shunt can, to a greater extent, be prevented.