The effect of splenomegaly on splanchnic hemodynamics in nonalcoholic cirrhosis after distal splenorenal shunt and splenopancreatic disconnection.

We investigated the effect of splenomegaly on portal hemodynamics during and after distal splenorenal shunt with splenopancreatic disconnection in 27 patients with nonalcoholic cirrhosis (13 with and 14 without splenic enlargement). Data were obtained by Doppler flowmetry, electromagnetic flowmetry and computed tomographical scanning. The splenomegaly group had a significantly higher preoperative splenic and portal blood flow than the nonsplenomegaly group. In both groups, postoperative portal venous pressure did not fall; portal blood flow significantly decreased while splenic volume was reduced, despite the lack of significant changes in splenic venous blood flow. There was a greater reduction of portal blood flow with previous splenomegaly than with normal-sized spleens, and this was not related to the degree of reduction in liver volume. In the splenomegaly group, the increase of splenic blood flow was only present during the early postoperative period. In conclusion, distal splenorenal shunt with splenopancreatic disconnection influenced portal hemodynamics differently in nonalcoholic cirrhotic patients with and without splenomegaly.