[Anatomic and surgical background for splenorenal venous transposition]

Unilateral portalization of adrenal and renal blood is used in clinical practice for arterial hypertension, chronic hepatitis and type 1 diabetes mellitus management. Left-sided renoportal venous anastomosis (RPVA), spleen vessel ligation and unilateral adrenalectomy (if indicated) are the technical backbone of the intervention. This operation was used for 50 patients with chronic hepatitis. Ten of them were investigated 15-19 years postoperatively. Positive effect on the disease progression was found in the absence of negative consequences for liver, kidneys and spleen. Ultrasonography has demonstra-ted patent anastomosis in all patients. In early postoperative period hyperthermia and epigastrial pain were registered in 14.3% of cases as a consequence of thrombosis in ligated spleen vein stump. The paper describes the development of splenorenal venous transposition (SRVT) technique as an improved variant of adrenal and renal blood unilateral portalization, in which spleen vessel ligation is replaced by splenorenal end-to-end anastomosis. The study included 111 cadaveric experiments. The technique of surgical intervention is described, its clinical requirements and potential obstacles. It is shown that SRVT can be fulfilled in 52.1% of cases with autovein graft. SRVT is more laborious and rare intervention, then single left-sided RPVA and must be initially practiced on cadavers. Indications for SRVT may include arterial hypertension, chronic hepatitis and type 1 diabetes mellitus.