AN EVALUATION OF SPLENOPANCREATIC DISCONNECTION AS A MODIFICATION OF THE DISTAL SPLENORENAL SHUNT, STUDIED IN NONALCOHOLIC PATIENTS BY SEQUENTIAL ANGIOGRAPHY

To evaluate the validity and complications of modifying the distal spl enorenal shunt (DSRS) by performing splenopancreatic disconnection (SP D), hemodynamic changes in the portal system were assessed by visceral angiography in 93 patients with nonalcoholic portal hypertension duri ng early postoperative follow-up after DSRS, There were 40 patients wh o underwent DSRS alone and 53 who under,vent DSRS plus SPD. Early foll ow-up angiography showed that portal vein perfusion was well maintaine d, and that the diameter of the portal vein had decreased significantl y by the same degree in both groups. Hepatofugal collaterals for the s hunt had developed to a greater extent in the DSRS group, while they w ere almost completely absent in the DSRS with SPD group. Nevertheless, partial portal vein thrombosis was not detected in the DSRS group, al though it was seen in seven (13.2%) of the patients who under,vent DSR S plus SPD, in whom the left proximal splenic vein was not visible, Th e proximal splenic vein was seen in significantly less of the DSRS,vit h SPD patients (47.2%) than the DSRS group patients (85%), In conclusi on, SPD more effectively prevented the early postoperative development of collateral pathways for the shunt compared with standard DSRS; how ever, the possible stagnation of blood Bow in the left proximal spleni c vein may predispose to a risk of partial portal vein thrombosis deve loping during the early postoperative period after DSRS with SPD.