The present prospective study was designed to evaluate the effects of splenectomy
and devascularization operation on the hemodynamics of portal circulation and the
reliability of color Doppler ultrasonography as a non-invasive tool in the assessment of
portal hemodynamics before and after the operation.
Thirty patients (19 males and 11 females) with clinical diagnosis of portal
hypertension and endoscopic evidence of oesophageal and/or gastric varices who
underwent splenectomy and devascularization were included to this study. The mean age
of the whole group was 32.121.8 years (range: 17-52 years). Doppler scanning of the
portal vein before and after the operation revealed a significant reduction in the maximum
blood velocity postoperatively (mean 10.592.66 cm/sec, versus 12.51 3.16 cm/sec
preoperatively), and a.significant reduction in the volume blood flow postoperatively
(mean 884.3+233.9 ml/min. versus 1073.8422.4 ml/min., preoperatively), and
insignificant change in the diameter. Also, the direction of blood flow was hepatopetal
in all patients after operation, while it was bidirectional in one patient and hepatopetal in
29 patients before operation. The study revealed a significant positive correlation between
the size of the spleen and the decrease in the blood velocity and volume blood flow of the
portal vein after operation. Also, there was a positively significant correlation between
die presence of a history of injection sclerotherapy and die diameter and volume blood
flow of the portal vein before the operation.
From the present study, it was concluded that splenectomy and devascularization
could be performed with extremely low mortality in selected elective patients, particularly
the non-alcoholic, with virtually no postoperative encephalopathy. This is in addition to
the preservation of the vascular anatomy of the right upper quadrant for future use in
potential liver transplant. The operation did not lead to complete disappearance of
oesophageal varices, but significant reduction in their grades and injection sclerotherapy
is recommended for variceal remnants. Based on the fact that there is a significant
positive correlation between the size of the spleen and the decrease in the blood velocity
and volume blood flow of portal vein after the operation, it is suggested that this splenic
venous flow contributes, in part, to portal hypertension.
The Doppler scanning is an ideal investigation for portal circulation, as it is noninvasive,
cheap and provides accurate data about the velocity, volume flow, direction of
blood flow and patency of portal circulation. |
