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Splenopancreatic disconnection. Improved selectivity of distal splenorenal shunt.
Ann Surg. 1986 Oct; 204(4):346-55.AnnS

Abstract

Distal splenorenal shunt (DSRS) improves survival from variceal bleeding in nonalcoholic cirrhotics but not in alcoholic subjects. The metabolic response after DSRS is also different in alcoholic and nonalcoholic cirrhotics. Portal perfusion, quality of blood perfusing the liver, cardiac output, and liver blood flow do not change in nonalcoholics. In alcoholics, portal perfusion is frequently lost (60%), quality of blood perfusing the liver decreases, and cardiac output and liver blood flow increase. It is proposed that portal flow is lost in alcoholics via pancreatic and colonic collaterals after surgery. Elimination of this sump by adding complete dissection of the splenic vein and division of the splenocolic ligament to DSRS (splenopancreatic disconnection, SPD) could preserve portal perfusion, decrease shunt loss of hepatotrophic factor, and improve survival in alcoholic cirrhotics. This report compares data 1 year after surgery in two groups of cirrhotics: group I (8 nonalcoholic; 16 alcoholic) had DSRS without SPD; group II (17 nonalcoholic; 11 alcoholic) received DSRS + SPD.

METHODS

Portal perfusion grade, cardiac output (CO), liver blood flow (f), hepatic function (GEC), and hepatic volume (vol) were measured before and 1 year after surgery. Shunt loss of hepatotrophic factor was estimated by insulin response (change in plasma concentration over 10 minutes: AUC) after arginine stimulation.

RESULTS

Groups I and II were similar before surgery. Metabolically, nonalcoholics remained stable after both DSRS and DSRS + SPD. After standard DSRS, alcoholics lost portal perfusion (75%, p less than 0.05), CO, and f increased (p less than 0.05), and quality of blood perfusing the liver was decreased (GEC/f: p less than 0.05). DSRS + SPD preserved portal perfusion better (p less than 0.05) in alcoholic cirrhotics than did DSRS alone. After DSRS + SPD, the metabolic response in alcoholics resembled that of nonalcoholics. CO, f, and GEC/f remained stable. These data show: DSRS + SPD preserves postoperative portal perfusion in alcoholic cirrhotics better than DSRS alone. Metabolic response to DSRS + SPD is similar in alcoholic and nonalcoholic cirrhotics. Because portal perfusion and metabolic integrity are preserved after DSRS + SPD, its use in alcoholic cirrhotics should improve survival.

Authors

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Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

3532968

Citation

Warren, W D., et al. "Splenopancreatic Disconnection. Improved Selectivity of Distal Splenorenal Shunt." Annals of Surgery, vol. 204, no. 4, 1986, pp. 346-55.
Warren WD, Millikan WJ, Henderson JM, et al. Splenopancreatic disconnection. Improved selectivity of distal splenorenal shunt. Ann Surg. 1986;204(4):346-55.
Warren, W. D., Millikan, W. J., Henderson, J. M., Abu-Elmagd, K. M., Galloway, J. R., Shires, G. T., Richards, W. O., Salam, A. A., & Kutner, M. H. (1986). Splenopancreatic disconnection. Improved selectivity of distal splenorenal shunt. Annals of Surgery, 204(4), 346-55.
Warren WD, et al. Splenopancreatic Disconnection. Improved Selectivity of Distal Splenorenal Shunt. Ann Surg. 1986;204(4):346-55. PubMed PMID: 3532968.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Splenopancreatic disconnection. Improved selectivity of distal splenorenal shunt. AU - Warren,W D, AU - Millikan,W J,Jr AU - Henderson,J M, AU - Abu-Elmagd,K M, AU - Galloway,J R, AU - Shires,G T,3rd AU - Richards,W O, AU - Salam,A A, AU - Kutner,M H, PY - 1986/10/1/pubmed PY - 2001/3/28/medline PY - 1986/10/1/entrez SP - 346 EP - 55 JF - Annals of surgery JO - Ann. Surg. VL - 204 IS - 4 N2 - UNLABELLED: Distal splenorenal shunt (DSRS) improves survival from variceal bleeding in nonalcoholic cirrhotics but not in alcoholic subjects. The metabolic response after DSRS is also different in alcoholic and nonalcoholic cirrhotics. Portal perfusion, quality of blood perfusing the liver, cardiac output, and liver blood flow do not change in nonalcoholics. In alcoholics, portal perfusion is frequently lost (60%), quality of blood perfusing the liver decreases, and cardiac output and liver blood flow increase. It is proposed that portal flow is lost in alcoholics via pancreatic and colonic collaterals after surgery. Elimination of this sump by adding complete dissection of the splenic vein and division of the splenocolic ligament to DSRS (splenopancreatic disconnection, SPD) could preserve portal perfusion, decrease shunt loss of hepatotrophic factor, and improve survival in alcoholic cirrhotics. This report compares data 1 year after surgery in two groups of cirrhotics: group I (8 nonalcoholic; 16 alcoholic) had DSRS without SPD; group II (17 nonalcoholic; 11 alcoholic) received DSRS + SPD. METHODS: Portal perfusion grade, cardiac output (CO), liver blood flow (f), hepatic function (GEC), and hepatic volume (vol) were measured before and 1 year after surgery. Shunt loss of hepatotrophic factor was estimated by insulin response (change in plasma concentration over 10 minutes: AUC) after arginine stimulation. RESULTS: Groups I and II were similar before surgery. Metabolically, nonalcoholics remained stable after both DSRS and DSRS + SPD. After standard DSRS, alcoholics lost portal perfusion (75%, p less than 0.05), CO, and f increased (p less than 0.05), and quality of blood perfusing the liver was decreased (GEC/f: p less than 0.05). DSRS + SPD preserved portal perfusion better (p less than 0.05) in alcoholic cirrhotics than did DSRS alone. After DSRS + SPD, the metabolic response in alcoholics resembled that of nonalcoholics. CO, f, and GEC/f remained stable. These data show: DSRS + SPD preserves postoperative portal perfusion in alcoholic cirrhotics better than DSRS alone. Metabolic response to DSRS + SPD is similar in alcoholic and nonalcoholic cirrhotics. Because portal perfusion and metabolic integrity are preserved after DSRS + SPD, its use in alcoholic cirrhotics should improve survival. SN - 0003-4932 UR - https://www.unboundmedicine.com/medline/citation/3532968/Splenopancreatic_disconnection__Improved_selectivity_of_distal_splenorenal_shunt_ L2 - http://Insights.ovid.com/pubmed?pmid=3532968 DB - PRIME DP - Unbound Medicine ER -