Splenic artery ligation during distal spleno-renal shunt [warren's operation]

Bleeding oesophageal varices as a complication of portal hypertension is the most common cause of upper gastrointestinal hemorrhage in Egypt. It is the leading cause of death in patients with schistosomal hepatic fibrosis and portal hypertension. Distal splenorenal shunt Distal splenorenal shunt [DSRS] is a surgical procedure designed to selectively and trans-splenically decompress oesophagogastric varices in patients with portal hypertension while preserving antegrade portal venous flow to the liver. The aim of this work is to study the effect of splenic artery ligation during distal splenorenal shunt [DSRS] on portal and splenic haemodynamics, splenic volume, haematological profile and oesophageal varices. Fifteen consecutive patients with portal hypertension, schistosomal hepatic fibrosis, and bleeding oesophageal varices were classified into 2 groups [A and B]. In group A, the eight patients were subjected to conventional DSRS and in group B the seven patients were subjected to splenic artery ligation during [DSRS]. The effect of DSRS on portal and splenic veins haemodynamics showed a significant decrease in Portal vein diameter [mm] [PVD], Portal vein velocity [cm/sec] [PVV] and Portal vein flow [L/min] [PVF]. Also, there was a significant increase in Splenic vein diameter [mm] [SVD], Splenic vein velocity [cm/sec] [SVV] and Splenic vein flow [L/min] [SVF] after construction of the shunt. Follow up of patients in this study revealed no significant difference between groups A and B as regards endoscopic changes, portal haemodynamics and splenic vein parameters. In group B, splenic venous thrombosis occurred in 2 patients [28.6%] who were treated medically and the shunt was patent lliree months later, while in group A the splenic venous flow was increased postoperatively with no case of shunt thrombosis. Routine comb/nation of splenic artery ligation to DSRS is not advised and it is only recommended in marked hypersplenism