Hemodynamic study after devascularization procedure in patients with esophageal varices.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Hepatology

Background:

• Esophageal varices are a serious complication of portal hypertension.
• Portal hypertension significantly increases portal venous pressure and blood flow.
• Surgical interventions like splenectomy and devascularization are used to manage portal hypertension.

Purpose of the Study:

• To investigate the effects of splenectomy and devascularization on portal and systemic hemodynamics in patients with esophageal varices.
• To determine the role of cardiectomy in the hemodynamic changes observed after surgical intervention.
• To understand the preservation of portal hypertensive status despite reduced portal venous blood flow.

Main Methods:

• Thermodilution method using a thermodilution catheter.
• Study included 23 patients with esophageal varices due to portal hypertension.
• Patients underwent splenectomy and devascularization, with or without cardiectomy.

Main Results:

• Splenectomy significantly decreased portal venous blood flow (0.99 to 0.67 L/min/m2) proportional to spleen weight.
• Portal venous pressure initially decreased post-splenectomy (36.5 to 29.1 cm H2O) but returned to baseline after devascularization.
• No significant difference in hemodynamic changes was observed between patients with and without cardiectomy.

Conclusions:

• Devascularization preserves portal hypertension despite reduced portal venous blood flow post-splenectomy.
• The observed hemodynamic changes are primarily attributed to the absence of splenic blood flow after splenectomy, not cardiectomy.
• Splenic blood flow plays a crucial role in maintaining portal hemodynamics in patients with portal hypertension.