THE EFFECT OF SPLENOMEGALY ON SPLANCHNIC HEMODYNAMICS IN NONALCOHOLICCIRRHOSIS AFTER DISTAL SPLENORENAL SHUNT AND SPLENOPANCREATIC DISCONNECTION

We investigated the effect of splenomegaly on portal hemodynamics duri ng and after distal splenorenal shunt with splenopancreatic disconnect ion in 27 patients with nonalcoholic cirrhosis (13 with and 14 without splenic enlargement). Data were obtained by Doppler flowmetry, electr omagnetic flowmetry and computed tomographical scanning. The splenomeg aly group had a significantly higher preoperative splenic and portal b lood how than the nonsplenomegaly group. In both groups, postoperative portal venous pressure did not fall; portal blood flow significantly decreased while splenic volume was reduced, despite the lack of signif icant changes in splenic venous blood how. There was a greater reducti on of portal blood how with previous splenomegaly than with normal-siz ed spleens, and this was not related to the degree of reduction in liv er volume. In the splenomegaly group, the increase of splenic blood fl ow was only present during the early postoperative period, In conclusi on, distal splenorenal shunt with splenopancreatic disconnection influ enced portal hemodynamics differently in nonalcoholic cirrhotic patien ts with and without splenomegaly.