An evaluation of splenopancreatic disconnection as a modification of the distal splenorenal shunt, studied in nonalcoholic patients by sequential angiography

Abstract

To evaluate the validity and complications of modifying the distal splenorenal shunt (DSRS) by performing splenopancreatic disconnection (SPD), hemodynamic changes in the portal system were assessed by visceral angiography in 93 patients with nonalcoholic portal hypertension during early postoperative follow-up after DSRS. There were 40 patients who underwent DSRS alone and 53 who underwent DSRS plus SPD. Early follow-up angiography showed that portal vein perfusion was well maintained, and that the diameter of the portal vein had decreased significantly by the same degree in both groups. Hepatofugal collaterals for the shunt had developed to a greater extent in the DSRS group, while they were almost completely absent in the DSRS with SPD group. Nevertheless, partial portal vein thrombosis was not detected in the DSRS group, although it was seen in seven (13.2%) of the patients who underwent DSRS plus SPD, in whom the left proximal splenic vein was not visible. The proximal splenic vein was seen in significantly less of the DSRS with SPD patients (47.2%) than the DSRS group patients (85%). In conclusion, SPD more effectively prevented the early postoperative development of collateral pathways for the shunt compared with standard DSRS; however, the possible stagnation of blood flow in the left proximal splenic vein may predispose to a risk of partial portal vein thrombosis developing during the early postoperative period after DSRS with SPD.

Combined devascularization and proximal splenorenal shunt: is this a better option than either procedure alone?

“…It was reported that, in PSRS, PVF and FPP were reduced markedly, as was the congestive condition caused by portal hypertension, but hepatofugal flow developed to a greater extent than with PCDV. [11][12][13][14][15][16] However, Spina et al 17 reported that the persistence of a high portal pressure allowed for the preservation of hepatopedal flow in 87% of cases.…”

A Large Spontaneous Splenorenal Shunt in a Patient with Liver Cirrhosis and Uncomplicated Portal Hypertension

“…It is able to ameliorate or prevent hepatic encephalopathy [28,29,[34][35][36] and is useful in the presence of contraindications for other surgical measures [6,34,37,38]. In the modified distal splenorenal shunt with splenopancreatic disconnection, the possible stagnation of blood flow in the left proximal splenic vein may predispose to a risk of partial portal vein thrombosis developing during the early postoperative period [32]. Especially in children, in whom portal hypertension, hypersplenism, and esophageal varices represent a very difficult clinical problem, surgical distal splenorenal shunt represents an effective and safe therapy of gastroesophageal varice bleeding and can also ment increases the white blood cell and platelet counts [28].…”