Splenic artery
ligation, a simple
surgical procedure expected to decrease splenic flow and portal pressure in patients with
cirrhosis of the liver, was performed concomitantly with a distal
splenorenal shunt procedure in six patients and as the main
surgical procedure in two patients. Immediate cessation of
bleeding was achieved in the four patients in whom the splenic artery was ligated to reduce intraoperative
bleeding. However, three of the seven patients with previous gastroesophageal
hemorrhage rebled from various postoperatively. Symptoms of
splenic infarction were observed in six patients, resulting in
thrombosis of the splenic vein and/or of the distal
splenorenal shunt in four patients and necessitating
splenectomy in one. This incidence of
thrombosis of the distal
splenorenal shunt is much higher than the overall incidence of 5 per cent observed at our institution. It is thus concluded that the splenic artery should not be ligated in cirrhotic patients with patent distal
splenorenal shunts, since splenic arterial collateral vessels have already been reduced by the gastric devascularization, an integral component of the distal
splenorenal shunt.