[Warren's operation for distal splenorenal anastomosis. A pre- and postoperative radiological study (author's...

The results of radiological examinations of 19 patients before and after Warren's operation for distal splenorenal anastomosis are reported, and compared to those of clinical and hemodynamic investigations. Good clinical results were obtained in this series in that there were no cases of relapse with hemorrhage, severe manifestations of encephalopathy, and/or hepatic insufficiency. Death occurred in 3 out of the 19 patients. Hemodynamic studies demonstrated a reduction in hepatic blood flow, persistence of a superior hepatic gradient after operation reduction in blood flow in the anastomosis after clamping of the splenic artery during operation, which demonstrates the importance of splenic artery blood flow in maintaining the permeability of the anastomosis, and persistence of high portal vein pressure during operation and after anastomosis. Radiological examination showed that the anastomosis was permeable in all the cases in this series. The hepatic portal circulation, as measured by the diameter of the portal vein and the amount of intrahepatic protal vascularization, was reduced after the operation. This diminution increased with time, as shown by studies carried out 6 months and 1 year after the operation in 3 patients. Portogastric separation was effective in only 6 cases. In the other cases, the hepatic collateral venous circulation persisted, appeared, or increased. The gastric varices were seen to be draining into the splenorenal anastomosis in 2 cases followed-up after the operation. It appears, therefore, that distal splenorenal anastomosis produces a progressive portocaval by-pass. Comparing these results with those obtained in three other series reported in the published literature (WARREN [12], MOSIMANN [8], and VANG [17], showed that they were close to those obtained by VANG, as far as reduction in intrahepatic portal circulation is concerned, but rather different from those of WARREN in respect to the efficacy of portogastric separation.