Splenopancreatic disconnection: improved selectivity of distal splenorenal shunt
Distal splenorenal shunt (DSRS) improves survival from variceal bleeding in nonalcoholic cirrhotics but not in alcoholic subjects. The metabolic response after DSRS is also different in alcoholic and nonalcoholic cirrhotics. Portal perfusion, quality of blood perfusing the liver, cardiac output, and...
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| Veröffentlicht in: | Annals of surgery 1986-10, Vol.204 (4), p.346-355 |
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| creator | WARREN, W. D MILLIKAN, W. J. JR HENDERSON, J. M ABU-ELMAGD, K. M GALLOWAY, J. R SHIRES, G. T. III RICHARDS, W. O SALAM, A. A KUTNER, M. H |
| description | Distal splenorenal shunt (DSRS) improves survival from variceal bleeding in nonalcoholic cirrhotics but not in alcoholic subjects. The metabolic response after DSRS is also different in alcoholic and nonalcoholic cirrhotics. Portal perfusion, quality of blood perfusing the liver, cardiac output, and liver blood flow do not change in nonalcoholics. In alcoholics, portal perfusion is frequently lost (60%), quality of blood perfusing the liver decreases, and cardiac output and liver blood flow increase. It is proposed that portal flow is lost in alcoholics via pancreatic and colonic collaterals after surgery. Elimination of this sump by adding complete dissection of the splenic vein and division of the splenocolic ligament to DSRS (splenopancreatic disconnection, SPD) could preserve portal perfusion, decrease shunt loss of hepatotrophic factor, and improve survival in alcoholic cirrhotics. This report compares data 1 year after surgery in two groups of cirrhotics: group I (8 nonalcoholic; 16 alcoholic) had DSRS without SPD; group II (17 nonalcoholic; 11 alcoholic) received DSRS + SPD.
Portal perfusion grade, cardiac output (CO), liver blood flow (f), hepatic function (GEC), and hepatic volume (vol) were measured before and 1 year after surgery. Shunt loss of hepatotrophic factor was estimated by insulin response (change in plasma concentration over 10 minutes: AUC) after arginine stimulation.
Groups I and II were similar before surgery. Metabolically, nonalcoholics remained stable after both DSRS and DSRS + SPD. After standard DSRS, alcoholics lost portal perfusion (75%, p less than 0.05), CO, and f increased (p less than 0.05), and quality of blood perfusing the liver was decreased (GEC/f: p less than 0.05). DSRS + SPD preserved portal perfusion better (p less than 0.05) in alcoholic cirrhotics than did DSRS alone. After DSRS + SPD, the metabolic response in alcoholics resembled that of nonalcoholics. CO, f, and GEC/f remained stable. These data show: DSRS + SPD preserves postoperative portal perfusion in alcoholic cirrhotics better than DSRS alone. Metabolic response to DSRS + SPD is similar in alcoholic and nonalcoholic cirrhotics. Because portal perfusion and metabolic integrity are preserved after DSRS + SPD, its use in alcoholic cirrhotics should improve survival. |
| doi_str_mv | 10.1097/00000658-198610000-00002 |
| format | Article |
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Portal perfusion grade, cardiac output (CO), liver blood flow (f), hepatic function (GEC), and hepatic volume (vol) were measured before and 1 year after surgery. Shunt loss of hepatotrophic factor was estimated by insulin response (change in plasma concentration over 10 minutes: AUC) after arginine stimulation.
Groups I and II were similar before surgery. Metabolically, nonalcoholics remained stable after both DSRS and DSRS + SPD. After standard DSRS, alcoholics lost portal perfusion (75%, p less than 0.05), CO, and f increased (p less than 0.05), and quality of blood perfusing the liver was decreased (GEC/f: p less than 0.05). DSRS + SPD preserved portal perfusion better (p less than 0.05) in alcoholic cirrhotics than did DSRS alone. After DSRS + SPD, the metabolic response in alcoholics resembled that of nonalcoholics. CO, f, and GEC/f remained stable. These data show: DSRS + SPD preserves postoperative portal perfusion in alcoholic cirrhotics better than DSRS alone. Metabolic response to DSRS + SPD is similar in alcoholic and nonalcoholic cirrhotics. Because portal perfusion and metabolic integrity are preserved after DSRS + SPD, its use in alcoholic cirrhotics should improve survival.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/00000658-198610000-00002</identifier><identifier>PMID: 3532968</identifier><identifier>CODEN: ANSUA5</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott</publisher><subject>Biological and medical sciences ; Cardiac Output ; Collateral Circulation ; Esophageal and Gastric Varices - surgery ; Gastrointestinal Hemorrhage - surgery ; Humans ; Insulin - blood ; Liver - pathology ; Liver Circulation ; Liver Cirrhosis, Alcoholic - physiopathology ; Liver Function Tests ; Liver, biliary tract, pancreas, portal circulation, spleen ; Medical sciences ; Pancreas - blood supply ; Portal System - physiopathology ; Portasystemic Shunt, Surgical ; Splenic Vein - surgery ; Splenorenal Shunt, Surgical ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system</subject><ispartof>Annals of surgery, 1986-10, Vol.204 (4), p.346-355</ispartof><rights>1987 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1251296/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1251296/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,309,310,314,723,776,780,785,786,881,23909,23910,25118,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=7990241$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/3532968$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>WARREN, W. D</creatorcontrib><creatorcontrib>MILLIKAN, W. J. JR</creatorcontrib><creatorcontrib>HENDERSON, J. M</creatorcontrib><creatorcontrib>ABU-ELMAGD, K. M</creatorcontrib><creatorcontrib>GALLOWAY, J. R</creatorcontrib><creatorcontrib>SHIRES, G. T. III</creatorcontrib><creatorcontrib>RICHARDS, W. O</creatorcontrib><creatorcontrib>SALAM, A. A</creatorcontrib><creatorcontrib>KUTNER, M. H</creatorcontrib><title>Splenopancreatic disconnection: improved selectivity of distal splenorenal shunt</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>Distal splenorenal shunt (DSRS) improves survival from variceal bleeding in nonalcoholic cirrhotics but not in alcoholic subjects. The metabolic response after DSRS is also different in alcoholic and nonalcoholic cirrhotics. Portal perfusion, quality of blood perfusing the liver, cardiac output, and liver blood flow do not change in nonalcoholics. In alcoholics, portal perfusion is frequently lost (60%), quality of blood perfusing the liver decreases, and cardiac output and liver blood flow increase. It is proposed that portal flow is lost in alcoholics via pancreatic and colonic collaterals after surgery. Elimination of this sump by adding complete dissection of the splenic vein and division of the splenocolic ligament to DSRS (splenopancreatic disconnection, SPD) could preserve portal perfusion, decrease shunt loss of hepatotrophic factor, and improve survival in alcoholic cirrhotics. This report compares data 1 year after surgery in two groups of cirrhotics: group I (8 nonalcoholic; 16 alcoholic) had DSRS without SPD; group II (17 nonalcoholic; 11 alcoholic) received DSRS + SPD.
Portal perfusion grade, cardiac output (CO), liver blood flow (f), hepatic function (GEC), and hepatic volume (vol) were measured before and 1 year after surgery. Shunt loss of hepatotrophic factor was estimated by insulin response (change in plasma concentration over 10 minutes: AUC) after arginine stimulation.
Groups I and II were similar before surgery. Metabolically, nonalcoholics remained stable after both DSRS and DSRS + SPD. After standard DSRS, alcoholics lost portal perfusion (75%, p less than 0.05), CO, and f increased (p less than 0.05), and quality of blood perfusing the liver was decreased (GEC/f: p less than 0.05). DSRS + SPD preserved portal perfusion better (p less than 0.05) in alcoholic cirrhotics than did DSRS alone. After DSRS + SPD, the metabolic response in alcoholics resembled that of nonalcoholics. CO, f, and GEC/f remained stable. These data show: DSRS + SPD preserves postoperative portal perfusion in alcoholic cirrhotics better than DSRS alone. Metabolic response to DSRS + SPD is similar in alcoholic and nonalcoholic cirrhotics. Because portal perfusion and metabolic integrity are preserved after DSRS + SPD, its use in alcoholic cirrhotics should improve survival.</description><subject>Biological and medical sciences</subject><subject>Cardiac Output</subject><subject>Collateral Circulation</subject><subject>Esophageal and Gastric Varices - surgery</subject><subject>Gastrointestinal Hemorrhage - surgery</subject><subject>Humans</subject><subject>Insulin - blood</subject><subject>Liver - pathology</subject><subject>Liver Circulation</subject><subject>Liver Cirrhosis, Alcoholic - physiopathology</subject><subject>Liver Function Tests</subject><subject>Liver, biliary tract, pancreas, portal circulation, spleen</subject><subject>Medical sciences</subject><subject>Pancreas - blood supply</subject><subject>Portal System - physiopathology</subject><subject>Portasystemic Shunt, Surgical</subject><subject>Splenic Vein - surgery</subject><subject>Splenorenal Shunt, Surgical</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1986</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUF1PwyAUJUYz5_QnmPTB1yoXSgs-mJjFr2SJJvOdMEodpoMGuiX799JtLsoDXM6553A5CGWAbwGL6g4Pq2Q8B8FLGC75sJETNAZGEgwFPkXjBNG8EJSco4sYvzGGguNqhEaUUSJKPkYf8641znfK6WBUb3VW26i9c0b31rv7zK664DemzqJpB2xj-23mm6GtV20Wd_Jg3FAv166_RGeNaqO5OpwTNH9--py-5rP3l7fp4yzXlIo-rysCpEyjVhSXaUwueGNMQUVFCsKwbjgFKBvAChQrNAWGicKULQjBitMJeti7duvFytTauD6oVnbBrlTYSq-s_M84u5RffiOBMEg_TwZ8b6CDjzGY5qgFLIeI5W_E8hjxDiJJev337aPwkGnibw68ilq1TUjZ2nhsq4TApAD6A9oAhKs</recordid><startdate>19861001</startdate><enddate>19861001</enddate><creator>WARREN, W. D</creator><creator>MILLIKAN, W. J. JR</creator><creator>HENDERSON, J. M</creator><creator>ABU-ELMAGD, K. M</creator><creator>GALLOWAY, J. R</creator><creator>SHIRES, G. T. III</creator><creator>RICHARDS, W. O</creator><creator>SALAM, A. A</creator><creator>KUTNER, M. H</creator><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>19861001</creationdate><title>Splenopancreatic disconnection: improved selectivity of distal splenorenal shunt</title><author>WARREN, W. D ; MILLIKAN, W. J. JR ; HENDERSON, J. M ; ABU-ELMAGD, K. M ; GALLOWAY, J. R ; SHIRES, G. T. III ; RICHARDS, W. O ; SALAM, A. A ; KUTNER, M. 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Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>WARREN, W. D</creatorcontrib><creatorcontrib>MILLIKAN, W. J. JR</creatorcontrib><creatorcontrib>HENDERSON, J. M</creatorcontrib><creatorcontrib>ABU-ELMAGD, K. M</creatorcontrib><creatorcontrib>GALLOWAY, J. R</creatorcontrib><creatorcontrib>SHIRES, G. T. III</creatorcontrib><creatorcontrib>RICHARDS, W. O</creatorcontrib><creatorcontrib>SALAM, A. A</creatorcontrib><creatorcontrib>KUTNER, M. H</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>WARREN, W. D</au><au>MILLIKAN, W. J. JR</au><au>HENDERSON, J. M</au><au>ABU-ELMAGD, K. M</au><au>GALLOWAY, J. R</au><au>SHIRES, G. T. III</au><au>RICHARDS, W. O</au><au>SALAM, A. A</au><au>KUTNER, M. H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Splenopancreatic disconnection: improved selectivity of distal splenorenal shunt</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>1986-10-01</date><risdate>1986</risdate><volume>204</volume><issue>4</issue><spage>346</spage><epage>355</epage><pages>346-355</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><coden>ANSUA5</coden><abstract>Distal splenorenal shunt (DSRS) improves survival from variceal bleeding in nonalcoholic cirrhotics but not in alcoholic subjects. The metabolic response after DSRS is also different in alcoholic and nonalcoholic cirrhotics. Portal perfusion, quality of blood perfusing the liver, cardiac output, and liver blood flow do not change in nonalcoholics. In alcoholics, portal perfusion is frequently lost (60%), quality of blood perfusing the liver decreases, and cardiac output and liver blood flow increase. It is proposed that portal flow is lost in alcoholics via pancreatic and colonic collaterals after surgery. Elimination of this sump by adding complete dissection of the splenic vein and division of the splenocolic ligament to DSRS (splenopancreatic disconnection, SPD) could preserve portal perfusion, decrease shunt loss of hepatotrophic factor, and improve survival in alcoholic cirrhotics. This report compares data 1 year after surgery in two groups of cirrhotics: group I (8 nonalcoholic; 16 alcoholic) had DSRS without SPD; group II (17 nonalcoholic; 11 alcoholic) received DSRS + SPD.
Portal perfusion grade, cardiac output (CO), liver blood flow (f), hepatic function (GEC), and hepatic volume (vol) were measured before and 1 year after surgery. Shunt loss of hepatotrophic factor was estimated by insulin response (change in plasma concentration over 10 minutes: AUC) after arginine stimulation.
Groups I and II were similar before surgery. Metabolically, nonalcoholics remained stable after both DSRS and DSRS + SPD. After standard DSRS, alcoholics lost portal perfusion (75%, p less than 0.05), CO, and f increased (p less than 0.05), and quality of blood perfusing the liver was decreased (GEC/f: p less than 0.05). DSRS + SPD preserved portal perfusion better (p less than 0.05) in alcoholic cirrhotics than did DSRS alone. After DSRS + SPD, the metabolic response in alcoholics resembled that of nonalcoholics. CO, f, and GEC/f remained stable. These data show: DSRS + SPD preserves postoperative portal perfusion in alcoholic cirrhotics better than DSRS alone. Metabolic response to DSRS + SPD is similar in alcoholic and nonalcoholic cirrhotics. Because portal perfusion and metabolic integrity are preserved after DSRS + SPD, its use in alcoholic cirrhotics should improve survival.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>3532968</pmid><doi>10.1097/00000658-198610000-00002</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| source | Journals@Ovid Ovid Autoload; MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Biological and medical sciences Cardiac Output Collateral Circulation Esophageal and Gastric Varices - surgery Gastrointestinal Hemorrhage - surgery Humans Insulin - blood Liver - pathology Liver Circulation Liver Cirrhosis, Alcoholic - physiopathology Liver Function Tests Liver, biliary tract, pancreas, portal circulation, spleen Medical sciences Pancreas - blood supply Portal System - physiopathology Portasystemic Shunt, Surgical Splenic Vein - surgery Splenorenal Shunt, Surgical Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system |
| title | Splenopancreatic disconnection: improved selectivity of distal splenorenal shunt |
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