Effects of splenectomy, devascularization and esophageal transection on portal venous pressure and portal perfusion in cirrhotic patients with bleeding esophageal varices.

This investigation sought to determine the effects of splenectomy, devascularization and esophageal transection on portal venous pressure and portal perfusion in cirrhotic patients with a previous history of hemorrhage from esophageal varices. From June 1988 to June 1991, 54 patients with liver cirrhosis underwent this nonshunting procedure for esophageal varices. Of these patients, 24 patients (20 men and four women, 39 to 68 years of age, all in Child's class A) were examined for portal pressure before, during and after the nonshunting operations. Portal venous perfusion was assessed from the venous phase of the superior mesenteric arteriogram preoperatively and one year after surgery in 16 of these 24 patients. There was no significant change (p > 0.05) in cardiac output and systemic blood pressure after the operation. The portal venous pressure before surgery was 28.4 +/- 8.0 mmHg with a range from 18 to 44 mmHg. A statistically significant decrease (p < 0.05) in the portal pressure was observed after ligation of the splenic artery (26.6 +/- 8.9 mmHg), splenectomy (24.8 +/- 8.0 mmHg), and devascularization with transection (23.4 +/- 7.5 mmHg). No correlation between the portal pressure change and splenic weight was noted (p > 0.05). Postoperative portal perfusion remained the same or even improved in 15 of these 16 patients. Only in one patient was the portal perfusion worse after the operation; this patient developed encephalopathy about 18 months later. In conclusion, a significant reduction in portal pressure is noted after nonshunting procedures but a persistent, relatively high portal pressure is maintained. Good postoperative portal perfusion can also be maintained.(ABSTRACT TRUNCATED AT 250 WORDS)