Mesocaval and distal splenorenal shunts: Effect on hepatic function, hepatic hemodynamics, and portal systemic encephalopathy

Abstract

The effect of the mesocaval interposition shunt (n = 12) and the distal splenorenal shunt (n = 9) on the wedged hepatic venous pressure, the estimated hepatic blood flow, quantitative hepatic function, and the rate of portal systemic encephalopathy was evaluated in 21 patients who had bled from esophageal varices. After mesocaval shunt the wedged hepatic venous pressure was significantly reduced by 42% (from 26 +/- 3 mm Hg to 15 +/- 5 mm Hg, P less than 0.001) compared to 16% only (from 25 +/- 3 mm Hg to 21 +/- 2 mm Hg, P less than 0.005) after distal splenorenal shunt. The estimated hepatic blood flow also decreased significantly after mesocaval shunt by 61% (from 1.45 +/- 0.46 l/min to 0.56 +/- 0.25 l/min, P less than 0.001) compared to 29% (from 1.29 +/- 0.32 l/min to 0.91 +/- 0.39 l/min, P less than 0.05) after distal splenorenal shunt. Despite significantly different influences of both types of shunt operations on wedged hepatic venous pressure and estimated hepatic blood flow (P less than 0.001), postoperative changes of hepatic function were comparable in both groups of patients. The galactose elimination capacity, the initial plasma disappearance rate of Bromsulphalein, and the plasma ratio of valine, leucine, and isoleucine to phenylalanine and tyrosine were reduced by 13%, 26%, and 29%, respectively, after mesocaval shunt, compared to 12%, 25%, and 17% after distal splenorenal shunt. Only two patients of the mesocaval shunt group with the largest decrease in estimated hepatic blood flow developed portal systemic encephalopathy postoperatively, and the distal splenorenal shunt patients with their minor hemodynamic sequelae remained free of portal systemic encephalopathy.

Acquired hepatocerebral degeneration: clinical characteristics and MRI findings

“…The existence of portosystemic shunts, detected on abdominal CT scans, was the most relevant hepatic abnormality preceding AHD in our patients. This finding is in keeping with results from other studies in which a chronic hepatic encephalopathy was observed in patients with portosystemic shunts because of noncirrhotic liver diseases such as schistosomiasis [31] or congenital cystic fibrosis [29], or conditions not involving hepatic damage such as portal vein thrombosis [30] or surgical shunting [32,33].…”

Effect of mesocaval interposition shunting and repeated sclerotherapy on blood levels of gastrointestinal regulatory peptides, amino acids, and lysosomal enzymes ‐ a prospective randomised trial

“…The findings of serum BCAA level changes in the present study correlate to some extent with those of Herz et al (31) where patients operated with shunt displayed a more pronounced reduction of the three BCAA after MIS than after DSRS. The latter group in their study had a better preserved hepatopetal portal flow, compared to our MIS patients who all had a reversed portal flow after 24 months of follow-up.…”

Transjugular Intrahepatic Portosystemic Shunt and Hepatic Encephalopathy

“…In this situation where the portal inflow is negligible or absent, the arterial flow and flow direction determine the EHBF. In most patients, the increase in arterial flow will not fully compensate for the reduction or loss of the portal flow [1,34,35]. Unfortunately, the magnitude of the decrease in EHBF after a shunt cannot be predicted since neither the increase in arterial flow nor the proportion of arterioportal 'steal' can be measured in advance of the operation or in tervention.…”