Related Experiment Video
Updated: Jun 16, 2026
04:00
Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
Portal flow and hepatic function after splenectomy and esophagogastric devascularization.
Darcy L M Carvalho1, Armando Capua, Pedro L S Leme
1Surgery Department, Santa Casa São Paulo Faculty of Medical Sciences, São Paulo, Brazil. lauga@terra.com.br
International Surgery
|January 21, 2010
Summary
Schistosomiasis patients with portal hypertension underwent azygoportal disconnection and splenectomy. Surgery reduced portal blood flow but did not impair hepatic function over three years.
Area of Science:
- Hepatology
- Gastroenterology
- Surgical Gastroenterology
Background:
- Schistosomiasis mansoni can cause portal hypertension and esophageal varices, leading to digestive bleeding.
- Azygoportal disconnection and splenectomy are surgical options for managing these complications.
Purpose of the Study:
- To evaluate the long-term effects of azygoportal disconnection and splenectomy on portal hemodynamics and hepatic function.
- To assess portal blood flow and liver function in patients with schistosomiasis-induced portal hypertension before and after surgery.
Main Methods:
- Doppler ultrasound was used to measure portal blood flow changes over a 3-year period.
- Child-Turcotte-Pugh criteria assessed hepatic functional reserve pre- and postoperatively.
- Study included 27 patients with mansonic schistosomiasis and portal hypertension.
Main Results:
- Portal blood flow significantly decreased by 27% post-surgery, reaching 37% reduction within two years.
- Portal flow remained stable after the second year postoperatively.
- All patients maintained good hepatic functional reserve, with no observed hepatic deterioration after surgery.
Conclusions:
- Azygoportal disconnection and splenectomy effectively reduce portal blood flow in schistosomiasis patients.
- The surgical procedure does not compromise hepatic function, even with significant portal flow reduction.
- This surgical approach is safe and effective for managing portal hypertension in schistosomiasis.
Related Concept Videos
01:21Hepatic Portal System
The hepatic portal system, a critical part of our circulatory framework, transports nutrient-laden, deoxygenated blood from the gastrointestinal tract and spleen to the liver. This ingenious system plays an indispensable role in maintaining our body's metabolic equilibrium.
At its core, the hepatic portal vein is the result of a confluence of the superior and inferior mesenteric veins along with the splenic vein. Each of these veins has a unique role. The superior mesenteric vein is responsible...
At its core, the hepatic portal vein is the result of a confluence of the superior and inferior mesenteric veins along with the splenic vein. Each of these veins has a unique role. The superior mesenteric vein is responsible...
01:28Esophageal Varices-II: Clinical Features and Management
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
01:24Esophageal Varices-I: Introduction
Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug binding...
01:22Portal Hypertension
Portal hypertension is an increase in blood pressure within the portal venous system. Normally, this pressure is less than 5 mmHg. It is considered clinically significant when it rises above 10 mmHg. At this threshold, complications from altered blood flow and venous congestion emerge.EtiologyPortal hypertension arises from conditions that impede blood flow through the liver. The most common cause is cirrhosis, in which chronic liver injury leads to fibrotic scarring. This fibrosis narrows or...
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess the...