HPB International Correspondence

Klinische Leberbefunde nach einaahme oraler Kontrazeptiva.mangioma of the liver with pain, fever and abnormal liver tests. (1983) Cavernous hemangioma of the liver: resect or observe? Am. Professor Myburgh's commentary makes several interesting observations about our paper. However, we would like to discuss his comment that by extrapola-tion of our results it can be assumed that 68% of our patients with calibrated porta caval shunts lost hepa-topetal portal perfusion. In patients with l Omm grafts, our data showed that hepatopetal flow was maintained at 1 year in 7 of 10 patients (70%) who underwent arteriogra-phy. Logically if these findings are extrapolated to our series of 19 patients with lOmm grafts one would expect to find-hepatopetal flow in 13 patients .-In patients with 12mm grafts, as Professor Myburgh states, the earlier work of Sarfeh and his colleagues 1'2 using a combination of fluoroscopy and selective angiography demonstrated that only 1 of their 12 patients receiving a 12-14 mm graft maintained pro-grade portal flow at one week after surgery. Therefore, we may assume that none of the four patients with 12 mm grafts of our series have maintained prograde portal flow. In patients with 8 mm grafts, as nine of the 11 patients of Sarfeh's series maintain prograde portal flow, we may assume that our two patients with 8 mm graft would have retained prograde flow. Overall consideration of our 25 patients gives a total of 15 patients (60%) who retained prograde flow and not 32% as suggested by Professor Myburgh. Nevertheless we would agree with him that there is no absolute correlation between the occurrence of en-cephalopathy and maintained por.tal venous perfusion. In this respect, the work of Sarfeh (2) revealed a correlation between the occurence of encephalopathy and the presence of reversed flow (35% encephalopathy in those with reversed portal flow compared with 9% in patients with prograde portal flow p 0.02) but other workers have reported that factors other than straightforward preservation of pro-grade portal flow are involved in the development of post operative an-cephalopathy-for example, augmentation of hepatic arterial perfusion of the liver after partial decom-pression 3 and maintenance of mesenteric venous hy-pertension limiting the absorption of nitrogenous compounds'. We are currently evaluating the long term results of surgery in these patients and in further patients with cirrhosis who have undergone the calibrated partial portocaval shunt. The results in our series which now stands at 43 patients tends to …