Effects of selective double portazygous disconnection and devascularization on hemodynamics of the portal venous system

Abstract

Aim: Selective double portazygous disconnection with preserving vagus (SDPDPV) is currently used for the therapy of portal hypertension. Doppler ultrasonography (DU) has been proposed for non-invasive evaluation of splanchnic hemodynamics, but the effect of SDPDPV on portal vein (PV) hemodynamics has not been analyzed with DU. This was the aim of the study. Material and methods: Two hundred and thirty six patients with cirrhotic portal hypertension who underwent either SDPDPV or pericardial devascularization with splenectomy (PDS) for variceal bleeding were enrolled. The hemodynamics parameter, operation-relevant information, change of lavatory examination data, postoperative complications, and clinical outcomes were analyzed. Results: The free portal pressure (FPP) in the SDPDPV group was significantly lower than the PDS group after operation (p<0.05). Velocities and blood flow of PV after SDPDPV decreased; however, when the hepatic artery (HA) and superior mesenteric vein (SMV) increased, the differences were significant (p<0.05). The correlation between the decreased FPP and changed blood flow of portal vein(PVF), hepatic artery (HAF) or superior mesenteric vein (SMVF) was significant (p<0.05) after SDPDPV. The difference between pre and postoperative values of portal congestion index (CI) in SDPDPV was significant (p<0.05). Occurrences or development of postoperative rebleeding showed a great difference between the two groups (p< 0.05). PVF and SMVF were significant independent indicators of postoperative rebleeding (p< 0.05). Conclusions: Compared with the PDS, the SDPDPV apparently decreased the blood velocity and blood flow of PV, and increased that of HA and SMV which has a beneficial effect on hepatic function and encourages the controlof the recurrent bleeding from varices. PVF and SMVF may be value indicators in predicting postoperative rebleeding.