Evaluation of splenectomy and devascularization operation on portal hemodynamics using Doppler ultrasonography

ABSTRACT

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 in this study. The mean age of the whole group was 32.12 +/- 1.8 years [range 17-52 years]. Doppler scanning of the portal vein before and after the operation revealed a sign reduction in the maximum blood velocity postoperatively [mean 10.59 +/- 2.66 cm/sec. versus 12.51 +/- 3.16 cm/sec preoperatively], and a sign reduction in the volume blood flow postoperatively [mean 884.3 +/- 233.9 ml/mm. versus 1073.8 +/- 422.4 ml/mm., 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 sign 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 sign correlation between the presence of a history of injection sclerotherapy and the 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 quad rant for future use in potential liver transplant. The operation did not lead to complete disappearance of oesophageal varices, but sign reduction in their grades and injection sclerotherapy is recommended for variceal remenants. Based on the fact that there is a sign 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