Clinical and pathophysiological aspects of splenectomy and selective splenic artery ligation in patients with decompensated portal hypertension

Abstract

The research aims to demonstrate the difference in approaches to correcting hypersplenism in portal hypertension of various etiology. Materials and methods. The approach of splenectomy (SE) and splenic artery ligation (SAL) without removal of the spleen during portoazygos disconnection in patients with upper variceal bleeding was compared. Differences in hematological changes and portal hemodynamics in the postoperative period were evinced. Participants: patients (n=37) with decompensated portal hypertension complicated by variceal bleeding, who underwent porto-azygos dissection and splenectomy formed group 1 (n=20), those who underwent porto-azygos dissection and splenic artery ligation formed group 2 (n=17). The comparative characteristics of surgical interventions in the two groups were performed. Results. Diameter of the portal vein, blood flow and congestion index were correlated with spleen size and type of surgical intervention (p < 0.005). The increase in thrombotic activity after splenectomy was characterized by an increase in the number of platelets and changes in blood coagulation. Complications in the form of thrombosis of the portal and superior mesenteric veins were observed in patients after splenectomy with concomitant Covid-19 infection. In the patients of the second group, thromboembolic complications were not observed, instead, there were purulent-septic complications in the form of splenic infarction, subdiaphragmatic and intrapleural accumulation of pathological contents. Conclusions. In the studied cohort of patients, the performance of splenectomy indicates a clinically significant improvement in portal hemodynamics. Decrease of intrahepatic blood flow due to reduction of splenic blood flow leads to improvement of liver function. Any type of reduction in splenic blood flow leads to an increased risk of thrombosis in the portal vein system.