Haemodynamics after distal splenorenal shunt.

Haemodynamic studies were made both preoperatively and 7--62 months after the operation in 17 cirrhotic patients subjected to distal splenorenal shunt. Patent shunt was demonstrated in all patients. Preoperatively all patients had hepatopetal portal flow. Postoperatively portography through percutaneous transhepatic portal vein cannulation demonstrated hepatopetal flow in nine patients and reversed flow in eight patients. Portal pressure was significantly decreased in both groups after the shunt (p less than 0.01). However, no differences in pre- and post-operative portal pressure were observed in the two patient groups. In patients with hepatopetal flow, minimal new collaterals without clear connection to gastroesophageal region could be demonstrated. Collateral formation in patients with reversed flow was more abandoned but, even in these cases, no connection to gastroesophageal region could be demonstrated. The results indicate that a continuous increase in liver resistance due to the progression of the liver disease is the main cause of changes in portal circulation.