SUBTOTAL SPLENECTOMY AND PORTAL VARICEAL DISCONNECTION IN THE TREATMENT OF PORTAL-HYPERTENSION

Bleeding gastroesophageal varices caused by portal hypertension can be treated successfully by subtotal splenectomy and central splenorenal shunting. However, in elderly patients and those at high risk of hepat ic failure, congestive heart failure and encephalopathy or when spleno renal anastomosis is impossible, an alternative is subtotal splenectom y and portal variceal disconnection. The author reports on the first n ine patients who underwent this procedure and describes the operative technique. Complications of the operation were minimal. One patient ha d thrombocytosis, but this was controlled clinically. No patient exper ienced encephalopathy during a follow-up ranging from 10 months to 8 y ears. No rebleeding was noted in seven of the patients, but two had a bleeding duodenal ulcer, which was treated successfully. Liver functio n was preserved in all patients. These results have encouraged the aut hor to continue investigation of subtotal splenectomy and portal varic eal disconnection.