Abstract
Systemic and splanchnic hemodynamics were studied before and six months after a portal systemic shunt (n=6) or a Sugiura procedure (n=9) in 15 patients with cirrhosis and a past history of variceal bleeding. Hepatic blood flow was estimated by hepatic extraction and clearance of continuous indocyanine green infusion. Azygos blood flow was measured with a continuous thermodilution catheter. After portocaval shunt, the cardiac index increased significantly from 4.0±1.4 to 5.4±0.8 l/min m2 (p<0.05), the hepatic venous pressure gradient and hepatic blood flow were significantly decreased from 21±3 to 13±5 mm Hg (p<0.05) and from 1.20±0.35 to 0.37±0.16 l/min (p<0.05) respectively. The decrease in azygos blood flow was not significant (0.51±0.31 vs 0.25±0.33 l/min; p=0.1). After Sugiura procedure, there was no significant change in cardiac index, hepatic venous pressure gradient, hepatic blood flow or azygos blood flow. This is the first study to show the long-term maintenance of splanchnic and systemic hemodynamics in patients with cirrhosis after Sugiura procedure. The absence of long-term hemodynamic alterations could explain the absence of encephalopathy after this procedure.
Highlights
Surgical prevention of recurrent variceal bleeding in patients with portal hypertension can be obtained by decreasing variceal pressure by portal systemic shunting or eradicating esophageal varices
The results of this study demonstrate that significant changes in splanchnic and systemic hemodynamics occur after portocaval shunt but not after Sugiura procedure in patients with cirrhosis
Six months after the Sugiura procedure there were no significant alterations of hepatic venous pressures, hepatic blood flow or cardiac index
Summary
Surgical prevention of recurrent variceal bleeding in patients with portal hypertension can be obtained by decreasing variceal pressure by portal systemic shunting or eradicating esophageal varices. The hemodynamic changes resulting from portal blood diversion may increase the prevalence of hepatic encephalopathy and decrease survival rate1’2. The Sugiura procedure[3], including splenectomy, extensive esophago-gastric devascularization, and oesophageal transection should not decrease portal pressure and hepatic blood flow and should be better tolerated C. Vons, Service de Chirurgie, H6pital Antoine B6cl+re, 157, rue de la Porte de Trivaux, 92141 Clamart cedex.
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