[Portal perfusion following selective and non-selective diversions in portal hypertension]

Derivative procedures to treat portal hypertension deprive the liver of the portal flow. Selective procedures maintain portal perfusion to the liver, but, nevertheless, have a slow tendency to lost it; low diameter portosystemic shunts partially maintain also portal flow. A study to compare postoperative portal blood flow was designed. In twenty three patients, twelve of them with a distal spleno renal shunt (DSRS) and eleven with a low diameter mesocaval interposition shunt (12 mm. Ring Reinformaced GORE-TEX) (LDMCI) a portal blood flow determination using computerized liver perfusion scintigraphy was performed in the postoperative period. In the DSRS group, no case of encephalopathy or rebleeding was recorded. All shunts were patent. Preoperative liver perfusion scintigraphy (LPS) showed a portal perfusion index (PPI) of 38.26% (range 25.2 to 62%) and in the postoperative period a PPI of 13.7 (range 0.8 to 31.7%). In the LDMCI, one case of encephalopathy (9%) and one case of rebleeding (9%) was recorded. LPS showed a preoperative PPI of 28.13% (range 12.4 to 55.7%) and in the postoperative period a PPI of 10.57% (range 0.8 to 20.4%). In the postoperative period, either with a selective or no selective shunt, a reduction in portal blood flow to the liver is to be expected, more apparent in patients with a total shunt. LDMCI control effectively the recurrence of bleeding esophageal varices, maintaining portal perfusion, too. Thus, LDMCI constitutes and excellent alternative for patients in whom a selective shunt is not possible to perform or indicated, particularly in those with portal hypertension secondary to alcoholic liver cirrhosis.