Open AccessExclusion of Nonisolated Splenic Vein in Distal Splenorenal Shunt for Prevention of Portal Malcirculation
Author(s) -
Kiyoshi Inokuchi,
Kiichiro Beppu,
Nobuhiro Koyanagi,
Kenji Nagamine,
Makoto Hashizume,
Keizō Sugimachi
Publication year - 1984
Publication title -
annals of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.153
H-Index - 309
eISSN - 1528-1140
pISSN - 0003-4932
DOI - 10.1097/00000658-198412000-00007
Subject(s) - medicine , splenic vein , ligation , shunt (medical) , splenic artery , portal hypertension , radiology , portal venous pressure , surgery , gastric varices , portal vein thrombosis , portosystemic shunt , esophageal varices , thrombosis , cirrhosis
In an attempt to prevent portoprival 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, two 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 two patients and severe narrowing of a portal vein in another two. Considerable stealing flow was observed in these four 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 months after surgery. When the amount of nonisolated splenic vein embedded in the pancreas is minimized, portal malcirculation after distal splenorenal shunt can, to a great extent, be prevented.