Surgical treatment for portosystemic encephalopathy in patients with liver cirrhosis: Occlusion of portosystemic shunt in combination with splenectomy.
OBJECTIVE
Operative ligation of the portosystemic shunt may control hepatic encephalopathy effectively, but the subsequent increase in portal vein pressure (PVP) leads to high mortality. Splenectomy can decrease inflow into the portal system, resulting in decreased portal pressure.


METHODS
We retrospectively examined the effect of splenectomy in combination with shunt closure on portosystemic encephalopathy.


RESULTS
Clinical symptoms of encephalopathy disappeared in all six patients who underwent splenectomy in combination with portosystemic shunt ligation, with the exception of one patient who had relapsing encephalopathy after 6 months. Follow-up computed tomography showed complete obliteration of the portosystemic shunts, except in the one patient with relapsing encephalopathy who underwent balloon-occluded retrograde transvenous obliteration for the remaining splenorenal shunt 8 months after surgery. PVP significantly decreased after splenectomy. PVP did not increase to the baseline PVP value after ligation of the shunts, except in two patients who had elevated PVP after surgery: PVP increased from 18 to 19 mmHg after ligation in one patient and from 18 to 23 mmHg in one patient.


CONCLUSIONS
Splenectomy followed by surgical ligation of the portosystemic shunt may be feasible and safe for cirrhotic patients with portosystemic shunts.
Departments of Gastroenterological Surgery             Gastroenterology and Hepatology, Hiroshima University Hospital, Hiroshima,              Department of Gastroenterology, Kure Medical Center, Kure, Japan.
Hirotaka
H
Tashiro
Kentaro
K
Ide
Hironobu
H
Amano
Tsuyoshi
T
Kobayashi
Takashi
T
Onoe
Kohei
K
Ishiyama
Shintaro
S
Kuroda
Hirofumi
H
Tazawa
Hirotaka
H
Kono
Hiroshi
H
Aikata
Shoichi
S
Takahashi
Kazuaki
K
Chayama
Hideki
H
Ohdan