OBJECTIVETo investigate the relationship between perioperative free portal pressure (FPP) after devascularization or spleno-renal shunt operation added devascularization and rebleeding or encephalopathy in patients with portal hypertension, and evaluate the relationship between dynamic changes of FPP and surgical approaches.

METHODSThe clinical data of 170 patients with portal hypertension receiving devascularization or devascularization with spleno-renal shunt operation (combination group) from January 2001 to December 2007 were retrospectively analyzed. All patients were divided into three groups: low pressure group [L group, after devascularization FPP 22 mm Hg, n = 60) and combination group (C group, n = 47). There was no significant difference in preoperative Child-Pugh score and pre-operation FPP (P > 0.05) among the three groups. Perioperative FPP, morbidity of rebleeding and encephalopathy were compared with each other.

RESULTSThe values of postoperative FPP were (27.1 +/- 1.9) mm Hg, (20.8 +/- 1.8) mm Hg and (21.5 +/- 2.2) mm Hg among the H group, L group and C group respectively. The rebleeding rates were 21.7%, 4.6% and 4.5% among the three groups respectively. All the values in H group were higher than those in L group and C group remarkably. The encephalopathy rate in C group (10.4%) was higher than that in L group (7.0%) or H group (3.3%), but there were no statistical significance (P > 0.05).

CONCLUSIONSFPP after splenectomy and devascularization may be a basis of choice of surgical approaches in portal hypertension. The spleno-renal shunt operation should be performed in the patients when FPP is over 22 mm Hg after devascularization.