ANGIOGRAPHIC EVALUATION AFTER PORTAL BLOOD-FLOW PRESERVING OPERATIONS

We carried out a prospective study comparing postoperative portal angi ographic characteristics in patients with hemorrhagic portal hypertens ion treated electively by two different portal blood flow preserving p rocedures. Between 1986 and 1991, a total of 81 patients underwent ope ration: 38 selective shunts and 43 Sugiura-Futagawa procedures. Cirrho sis was shown by biopsy in 50 cases, 26 of them secondary to alcoholis m. We found rebleeding in 5% of the patients, incapacitating postopera tive encephalopathy in 8%, and an operative mortality of 7%. Fifty-two cases were evaluated in the postoperative period with angiography; 21 patients treated with a Sugiura-Futagawa operation were excluded due to portal vein thrombosis shown in the preoperative studies. Postopera tive portal vein thrombosis was found in 11 cases (21%) [seven cases i n the Warren group (21%) and four cases in the Sugiura-Futagawa group (20%)] Decreased portal vein diameter was seen in eight cases (15%). T he two procedures maintained hepatopedal portal blood flow, and no cha nge was seen in relation to the preoperative state in 66% of the opera ted patients. We found no significant differences between the two proc edures. Selection of procedure depends on the individual characteristi cs of each patient.