Does Open versus Arthroscopic Surgical Technique Affect the Union Rate of Tibiotalar Arthrodesis?

Category: Arthroscopy Introduction/Purpose: To date, there are only a handful of studies directly comparing outcomes of open versus arthroscopic ankle arthrodesis. Major limitations of these studies are small patient cohorts, lack of long-term follow-up, lack of assessment pre-operative patient demographics and imaging, and post-operatively evaluation of clinical outcomes but not union rates. The purpose of this clinical study is to compare the rate of union in ankle fusions in patients that underwent open arthrodesis to those that underwent arthroscopic arthrodesis. The hypothesis of this study was that there would be no difference in union rate in patients that underwent open versus arthroscopic arthrodesis. Methods: This is a retrospective review of 521 consecutive patients from October 2002 to April 2016. One hundred twenty-five ankles from 121 patients met inclusion criteria. These patients underwent primary tibiotalar arthrodesis without the use of autograft. Fifty-nine patients underwent open tibiotalar arthrodesis and 66 patients underwent arthroscopic tibiotalar arthrodesis. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was union rate of tibiotalar arthrodesis. Secondary outcome measures were time to union, rate of wound complications, rate of return to operating room, and rate of development of post-operative deep vein thrombosis (DVT). Results: One hundred twenty-one patients (125 ankles) were available for final follow-up. Average age of the patients was 55.3 +/- 17.2 years. Mean follow-up time was 35.4 months. Unions were assessed on routine post-operative radiographs. If there was a concern for nonunion, computerized tomography scan was utilized for further assessment. Nonunion rate of patients who had open surgery was 10/59 (17%) and nonunion rate of those who had arthroscopic surgery was 13/66 (20%) (p=0.69) [Table 1]. There was a statistically significant difference between those who had open versus arthroscopic surgery in wound complication rate (39% vs 6%, p=<0.001) and DVT rate (7% vs 0%, p=0.047). There was no statistically significant difference in rate of return to the operating room. No major complications occurred in this study. Conclusion: This study is the largest study to directly compare union rate and complications in patients who had open versus arthroscopic ankle arthrodesis. In this study, no significant association was found between surgical technique and union rate in patients undergoing ankle arthrodesis. Additionally, use of the arthroscopic technique has significantly lower rates of wound complication and post-operative DVTs.

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Comparison of Non-Union and Complication Rates in Primary versus Revision Tibiotalar Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00091 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0009

Author(s):

Julie Neumann ◽

Maxwell Weinberg ◽

Charles Saltzman ◽

Alexej Barg

Keyword(s):

Operating Room ◽

Ankle Arthrodesis ◽

Rate Of Return ◽

Wound Complications ◽

Complication Rates ◽

Ankle Arthritis ◽

Union Rate ◽

Tibiotalar Arthrodesis ◽

Complications Rate

Category: Ankle Arthritis Introduction/Purpose: Tibiotalar arthrodesis is generally a successful treatment option for patients with end stage ankle arthritis. However, there is a 9% risk of nonunion in patients undergoing primary tibiotalar arthrodesis. Patients with a nonunion often undergo revision ankle arthrodesis, as it is the most common salvage procedure in this situation. To date, only a few studies have evaluated outcomes in patients with revision ankle arthrodesis. The purpose of this clinical study is to directly compare the rate of union and complications in primary versus revision tibiotalar arthrodesis. The hypothesis of this study was that there would be no difference in rate of union and complications between primary and revision ankle arthrodesis. Methods: This is a retrospective review of 455 consecutive patients that underwent either primary or revision tibiotalar arthrodesis between March 2002 to November 2014. Three-hundred eighty-five patients underwent primary arthrodesis and 70 patients underwent revision arthrodesis. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was union rate of tibiotalar arthrodesis. Secondary outcome measures were time to union, rate of wound complications, rate of return to operating room, and rate of development of post-operative deep vein thrombosis (DVT). Results: Average age of the patients was 56 +/- 15 years (range 18-89). The mean follow-up time was 38.3 +/- 27.4 months (range 12-150.4 months). All patients had a minimum follow-up of 12 months. Unions were assessed on routine post-operative radiographs. If there was a concern for nonunion, patients were further assessed with a computerized tomography scan. The nonunion rate of patients who had primary arthrodesis was 37/385 (9.6%) and revision arthrodesis was 6/70 (8.5%) (p=0.74) (Table 1). Additionally, there was not a significant difference between those who had primary versus revision ankle arthrodesis surgery in rate of wound complication, return to the operating room, and post-operative DVT (Table 2). There were no major complications in this study. Conclusion: This is the largest study to directly compare union rates and complication rates in patients who underwent primary versus revision ankle arthrodesis. In this study, primary versus revision tibiotalar arthrodesis does not affect union rate, time to union, rate of wound complications, rate of return to operating room, and rate of development of post-operative DVT.

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Does Concurrent Distal Tibiofibular Joint Arthrodesis Affect the Nonunion and Complication Rates of Tibiotalar Arthrodesis?

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00367 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0036

Author(s):

Julie Neumann ◽

Maxwell Weinberg ◽

Chong Zhang ◽

Charles Saltzman ◽

Alexej Barg

Keyword(s):

Wound Complication ◽

Ankle Arthrodesis ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Wound Complications ◽

Complication Rates ◽

Vein Thrombosis ◽

Significant Difference ◽

Tibiotalar Arthrodesis ◽

End Stage

Category: Ankle Introduction/Purpose: Tibiotalar arthrodesis is generally a successful treatment option for patients with end stage ankle arthritis. However, there is a 9% risk of nonunion in patients undergoing primary tibiotalar arthrodesis. To date, it is unclear whether concurrent distal tibio-fibular joint arthrodesis affects this nonunion rate as there have been no studies directly comparing patients with and without arthrodesis of the distal tibio-fibular joint. The purpose of this clinical study is to compare the rate of nonunion in patients with a distal tibio-fibular fusion to those without a distal tibio-fibular fusion in the setting of a primary, open ankle arthrodesis. The hypothesis of this study was that the addition of a distal tibio-fibular fusion would decrease the nonunion rate in patients undergoing open ankle arthrodesis. Methods: This is a retrospective review of 521 consecutive patients from October 2002 to April 2016. 366 ankles from 354 unique patients met inclusion criteria. All patients underwent primary, open tibiotalar arthrodesis. 250 patients underwent open tibiotalar arthrodesis with a distal tibio-fibular fusion and 116 patients underwent open tibiotalar arthrodesis without a distal tibio-fibular fusion. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was nonunion rate of tibiotalar arthrodesis. Secondary outcome measures were time to union, rate of wound complications, and rate of development of post-operative deep vein thrombosis (DVT)/Pulmonary embolism (PE). Results: Average age of the patients was 56.2 +/- 14.2 years. Mean follow-up time was 33.8 months. Unions were assessed on routine post-operative radiographs and by clinical examination. If there was a concern for nonunion, computerized tomography scan was utilized for further assessment. Nonunion rate of patients who had the distal tibio-fibular joint included was 19/250 (8%) and nonunion rate of those who did not have the distal tibio-fibular joint fused was 14/116 (12%) (p=0.16). There was no significant difference between those who had the distal tibio-fibular joint included versus who did not in wound complication rate (27% vs 31%, p=0.40), time to union (4.9 weeks versus 5 weeks, p =0.54), and DVT/PE rate (5% vs 3%, p=0.41), respectively [Table 1]. There were no major complications. Conclusion: To our knowledge, this is the first study directly comparing nonunion rates and complication rates in patients who underwent primary, open ankle arthrodesis with and without distal tibio-fibular joint arthrodesis. In this study, inclusion of the distal tibio-fibular joint in tibiotalar arthrodesis does not affect nonunion rate in patients undergoing primary, open ankle arthrodesis. Additionally, inclusion of the distal tibio-fibular joint does not affect rate of wound complication, time to union, and DVT/PE rate.

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Does Use of Demineralized Bone Matrix Affect the Union Rate in Arthroscopic Ankle Fusions?

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00368 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0036

Author(s):

Julie Neumann ◽

Maxwell Weinberg ◽

Chong Zhang ◽

Charles Saltzman ◽

Alexej Barg

Keyword(s):

Operating Room ◽

Demineralized Bone Matrix ◽

Bone Matrix ◽

Ankle Arthrodesis ◽

Rate Of Return ◽

Secondary Outcome ◽

Wound Complications ◽

Union Rate ◽

Demineralized Bone

Category: Ankle Introduction/Purpose: Despite DBM having positive effects on union rates in other subspecialties of orthopaedics, there is a general lack of evidence about bone graft substitutes in foot and ankle surgery. To our knowledge, orthopaedic surgeons have never evaluated the use of demineralized bone matrix (DBM) as it pertains to the union rate of arthroscopic ankle fusions. The purpose of this clinical study is to compare the rate of union in arthroscopic ankle fusions in patients that have had DBM to those without DBM. The hypothesis of this study was that use of DBM would increase the union rate in all patients undergoing arthroscopic ankle arthrodesis. Methods: This is a retrospective review of 521 consecutive patients from October 2002 to April 2016. Seventy-one ankles from 68 patients met inclusion criteria. These patients underwent primary arthroscopic ankle arthrodesis. Forty patients had DBM and 31 patients did not have DBM. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was union rate of arthroscopic ankle arthrodesis. Secondary outcome measures were time to union, rate of wound complications, rate of return to operating room, and rate of development of post-operative deep vein thrombosis (DVT). Results: Seventy-one patients were available for final follow-up. Average age of the patients was 55.3 +/- 17.6 years. The mean follow-up time was 39.5 months. Unions were assessed on routine post-operative radiographs. If there was a concern for nonunion, patients were further assessed with a computerized tomography scan. Nonunion rate of patients who did have DBM was 7/40 (18%) and nonunion rate of those who did not have DMB was 8/31 (26%) (p=0.40). There was no statistically significant difference between those who did have DBM and those who did not have DBM in wound complication rate (5% vs 6%, p=1.0), rate of return to the operating room (35% vs 39%; p=0.75), and DVT rate (0% vs 0%), respectively. There were no major complications in this study. Conclusion: This study is the largest study to directly compare union rate and complications in patients who had DBM versus those who did not in the setting of arthroscopic ankle fusion. In this study, use of DBM does not affect union rate in patients undergoing arthroscopic ankle arthrodesis. Additionally, use of DBM does not affect the rate of wound complications, return to the operating room, and development of post-operative DVT.

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PO 18164 - Subtalar arthrodesis with bone graft

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.1023 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. S34

Author(s):

Henrique Mansur ◽

Gil Galvão Bernardes Silveira ◽

Isnar Moreira De Castro Junior

Keyword(s):

Bone Graft ◽

Donor Site ◽

Ankle Arthrodesis ◽

Foot And Ankle ◽

Union Rate ◽

Subtalar Arthrodesis ◽

Significant Difference ◽

Different Types ◽

Bone Autograft

Introduction: The bone graft is an important component of foot and ankle arthrodesis and is used in conditions in which the biological system is known to be unfavorable and scraping the joint will cause a considerable structural defect. The objective was to evaluate the union rate of subtalar arthrodesis in smokers and nonsmokers and to determine the effect of the use of different types of bone autografts. Methods: Retrospective study with radiological evaluation of patients diagnosed with subtalar arthrosis who underwent primary arthrodesis from January 2008 to December 2014. All patients with a minimum follow-up period of 12 months were included and were divided into smokers and nonsmokers treated with or without autologous bone grafting. Results: In total, 235 patients with a mean age of 47 years were evaluated; whom 90 (40%) were smokers, and 141 (60%) were nonsmokers. In 221 (94%) cases, the indication for arthrodesis was sequelae of calcaneal fractures. A bone graft was used in 27.7% patients. The overall union rate was 85.4%, and 14.6% of the patients developed pseudarthrosis. A significant difference was found in the nonunion rate of smokers versus nonsmokers (p=0.015), especially in those who did not receive a bone graft (p=0.014). However, no significant difference was found between smokers who received a bone graft and those who did not (p=0.072). The union rate was related to the donor site, with pseudarthrosis observed in 33.3% of surgeries involving a calcaneal autograft (p=0.011). Conclusion: Smoking increased the likelihood of pseudarthrosis in subtalar arthrodesis by 2.5 fold, and pseudarthrosis was related to the bone autograft donor site.

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Surgery of cholesteatoma: Surgical technique and cholesteatoma recurrences

Acta chirurgica iugoslavica ◽

10.2298/aci0401103a ◽

2004 ◽

Vol 51 (1) ◽

pp. 103-107

Author(s):

Nenad Arsovic ◽

Radomir Radulovic ◽

Snezana Jesic ◽

S. Krejovic-Trivic ◽

P. Stankovic ◽

...

Keyword(s):

Surgical Treatment ◽

Surgical Technique ◽

Complete Removal ◽

Initial Surgery ◽

Group I ◽

Number Of Patients ◽

Significant Difference ◽

Diffuse Form ◽

Surgical Failure

Past experience with open and closed techniques of tympanoplasty in surgery of cholesteatoma has shown that recurring illness is one of the major causes of surgical failure. The literature has reported varying trend of surgical treatment of cholesteatoma. The objective of the study was to analyze the significance of surgical technique in relation to the incidence and most frequent localization of recurrent cholesteatoma. Our study analyzed 120 patients operated on for cholesteatoma. The patients were divided into two groups, group I (45) with recurring disease and group II (75) without any recurring condition, which were followed up three years. Statistical analysis was carried out by modified t-test. The largest number of patients was re-operated in the first two years from the initial surgery (50%), In the majority of patients (50%), recurrent cholesteatoma was most commonly localized (stage I) in attic (20%) and much rarely in mesotympanum (11,9%). Stage III recurrent cholesteatoma was verified in 35% of patients, most frequently diffuse form (13,4%). The involvement of attic by all three stages of disease accounted for over 60%. The analysis of the used techniques of surgical treatment in both groups revealed significant difference. Open techniques of tympanoplasty were used in 60% of patients with no recurrence. Closed techniques were used more frequently in patients with recurring disease, i.e. in over 90% of cases. Recurrent cholesteatoma develops, in the majority of cases, during the first two years after the surgical intervention. Attic is the most common localization of cholesteatoma. More frequent utilization of open technique of tympanoplasty for surgery of cholesteatoma significantly reduces the incidence of recurring condition. The indications for CWD technique are the initial spread of cholesteatoma, possibility of complete removal of cholesteatoma and postoperative follow-up of patients.

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The Results of Carpal Tunnel Release: Open Versus Endoscopic Technique

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(94)90039-6 ◽

1994 ◽

Vol 19 (1) ◽

pp. 14-17 ◽

Cited By ~ 68

Author(s):

S. BANDE ◽

L. DE SMET ◽

G. FABRY

Keyword(s):

Patient Satisfaction ◽

Return To Work ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Endoscopic Technique ◽

Open Release ◽

Significant Difference ◽

Open Versus ◽

Portal Technique

We retrospectively compared two similar groups of patients who underwent either endoscopic decompression of the carpal tunnel (single portal technique, 44 patients) or open decompression (58 patients) during 1 year in our department. To find out whether there was any subjective difference between the results of the two techniques, we sent each patient a questionnaire and received a 95% response. No major complications occurred. Three endoscopic decompressions had to be abandoned, and open release was performed. We could not demonstrate any significant difference in relief of symptoms and return to work between the two groups. Patient satisfaction at 6 to 18 months follow-up was high with both techniques.

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Lower Signal Intensity of the Anterior Talofibular Ligament is Associated with a Higher Rate of Return to Sport After ATFL Repair for Chronic Lateral Ankle Instability

The American Journal of Sports Medicine ◽

10.1177/0363546519858588 ◽

2019 ◽

Vol 47 (10) ◽

pp. 2380-2385 ◽

Cited By ~ 7

Author(s):

Hong Li ◽

Yinghui Hua ◽

Sijia Feng ◽

Hongyun Li ◽

Shiyi Chen

Keyword(s):

Signal Intensity ◽

Functional Outcomes ◽

Ankle Instability ◽

Return To Sport ◽

Rate Of Return ◽

Anterior Talofibular Ligament ◽

Aofas Score ◽

Significant Difference ◽

The Mean

Background: The treatment strategy for anterior talofibular ligament (ATFL) injury is usually determined by the ATFL remnant condition during surgery. Preoperative magnetic resonance imaging (MRI)–based signal intensity of the ATFL remnant, represented by the signal/noise ratio (SNR) value, can reveal the ATFL remnant condition. Thus far, there is a lack of evidence regarding the relationship between the ATFL remnant condition and functional outcomes. Purpose/Hypothesis: The purpose was to quantitatively evaluate whether the MRI-based ATFL ligament SNR value is related to functional outcomes after ATFL repair for ankles with chronic lateral ankle instability. The hypothesis was that a lower preoperative SNR is related to a better clinical outcome, particularly a higher rate of return to sport. Study Design: Cohort study; Level of evidence, 3. Methods: First, a preliminary study was performed to measure the ATFL SNR in preoperative MRI, the results of which suggested that a preoperative SNR >10.4 was indicative of a poor ATFL condition. Then, a cohort study was retrospectively performed with consecutive patients who underwent open repair of ATFL injuries between January 2009 and August 2014. Accordingly, the patients were divided into 2 groups: high SNR (HSNR; ≥10.4) and low SNR (LSNR; <10.4). Functional outcomes based on the American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), and Tegner Activity Scale were then compared between the HSNR group and the LSNR group. Results: Ultimately, 70 patients were available for the final follow-up: 37 in the HSNR group and 33 in the LSNR group. No significant difference was detected between the HSNR group and the LSNR group in terms of the AOFAS score, KAFS, or Tegner Activity Scale ( P > .05 for all) preoperatively. At the final follow-up, the mean ± SD AOFAS score in the LSNR group (92 ± 6) was higher than that in the HSNR group (87 ± 12), although no significant difference was detected postoperatively ( P = .16). The mean KAFS in the LSNR group (94 ± 7) was significantly higher than that in the HSNR group (88 ± 11) postoperatively ( P = .03). At follow-up, the mean Tegner score in the LSNR group (6; range, 3-7) was significantly higher than that in the HSNR group (5; range, 1-8) postoperatively ( P = .03). Patients in the LSNR group had a significantly higher percentage of sports participation than those in the HSNR group (91% vs 65%, P = .02) postoperatively. Conclusion: A lower signal intensity in the ATFL ligament based on preoperative MRI is associated with a better clinical outcome, particularly a higher rate of return to sport.

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Ankle Arthrodesis: A Long-term Study

Foot & Ankle ◽

10.1177/107110079201300602 ◽

1992 ◽

Vol 13 (6) ◽

pp. 307-312 ◽

Cited By ~ 79

Author(s):

Richard V. Abdo ◽

Stephen A. Wasilewski

Keyword(s):

Ankle Arthrodesis ◽

Radiographic Examination ◽

Radiographic Evaluation ◽

Grading System ◽

Term Study ◽

Evaluation Score ◽

Long Term Study ◽

Significant Difference

Few studies of ankle arthrodesis have assessed tarsal mobility. This study was performed to evaluate radiographically the effect of ankle arthrodesis on tarsal motion. Thirty patients (31 ankles) returned for clinical and radiographic examination, review of charts, and completion of questionnarie forms. Radiographs were evaluated for success of fusion, position of fusion, tarsal motion, hindfoot position, and subtalar and midtarsal arthritis. The median follow-up time was 7.0 years (range 2–20 years). Results showed that fusion was achieved in 22 patients (71%). The evaluation score based on the grading system of Mazur et al. 16 correlated with success of fusion and patient satisfaction. However, no correlation existed between evaluation score and tarsal motion or position of fusion in the sagittal or coronal planes. Radiographic evaluation showed no significant difference between tarsal motion of the fused side and the unfused side. Tarsal mobility was not affected by ankle arthrodesis or by the techniques performed to achieve fusion.

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PO 18188 - Ankle arthrodesis via a transfibular approach and circular external fixation

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.1026 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. 37S

Author(s):

Rodrigo Yuzo Masuda ◽

Vinícius Felipe Pereira ◽

Nacime Salomão Barbachan Mansur ◽

Hilário Boatto ◽

Hélio Pereira da Cunha Neto ◽

...

Keyword(s):

Ankle Arthrodesis ◽

Functional Restoration ◽

Ilizarov Method ◽

Union Rate ◽

Aofas Score ◽

Circular External Fixator ◽

Ilizarov Apparatus ◽

Vas Scores ◽

The Mean

Objective: To present the radiographic and functional outcomes of a series of 11 cases of ankle arthrodesis operated on with a circular external fixator using the Ilizarov method and a transfibular approach from January 2017 to June 2018. Methods: The patients were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) scores. Anteroposterior and profile views of the ankle radiographs were evaluated. All patients underwent a similar procedure in terms of the surgical approach and assembly of the Ilizarov apparatus. Results: During the study period, 11 cases underwent surgery; the mean age was 44.81 years (28-70 years). The mean follow-up time was 50.81 weeks (13-90 weeks). The main indication for surgery was posttraumatic secondary arthritis. The mean functional AOFAS score was 55.72 (45-64) points. Soft-tissue evaluation revealed surgical wound healing of the transfibular approach in 9 patients (81%). All patients showed signs of superficial pin- or wire-tract infection. Union was reported in 10 patients (90.9%), and the radiographic varus deformities found in 2 patients did not exceed 7º. No additional surgical procedure was required during follow-up. Conclusion: Ankle arthrodesis using a transfibular approach and fixation using the Ilizarov method were efficient, promoted functional restoration considering the complexity of the cases, and resulted in a high union rate.

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Distal splenorenal shunt with partial spleen resection

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0706293g ◽

2007 ◽

Vol 135 (5-6) ◽

pp. 293-297 ◽

Cited By ~ 3

Author(s):

Predrag Gajin ◽

Bozina Radevic ◽

Dragoslav Nenezic ◽

Nenad Ilijevski ◽

Rada Jesic-Vukicevic ◽

...

Keyword(s):

Platelet Count ◽

Portal Hypertension ◽

Surgical Technique ◽

Splenorenal Shunt ◽

Oesophageal Varices ◽

Distal Splenorenal Shunt ◽

Total Hospital Stay ◽

Significant Difference ◽

The Mean

Introduction: Hypersplenism is a common complication of portal hypertension. Cytopenia in hypersplenism is predominantly caused by splenomegaly. Distal splenorenal shunt (Warren) with partial spleen resection is an original surgical technique that regulates cytopenia by reduction of the enlarged spleen. Objective. The aim of our study was to present the advantages of distal splenorenal shunt (Warren) with partial spleen resection comparing morbidity and mortality in a group of patients treated by distal splenorenal shunt with partial spleen resection with a group of patients treated only by a distal splenorenal shunt. Method. From 1995 to 2003, 41 patients with portal hypertension were surgically treated due to hypersplenism and oesophageal varices. The first group consisted of 20 patients (11 male, mean age 42.3 years) who were treated by distal splenorenal shunt with partial spleen resection. The second group consisted of 21 patients (13 male, mean age 49.4 years) that were treated by distal splenorenal shunt only. All patients underwent endoscopy and assessment of oesophageal varices. The size of the spleen was evaluated by ultrasound, CT or by scintigraphy. Angiography was performed in all patients. The platelet and white blood cell count and haemoglobin level were registered. Postoperatively, we noted blood transfusion, complications and total hospital stay. Follow-up period was 12 months, with first checkup after one month. Results In the first group, only one patient had splenomegaly postoperatively (5%), while in the second group there were 13 patients with splenomegaly (68%). Before surgery, the mean platelet count in the first group was 51.6?18.3x109/l, to 118.6?25.4x109/l postoperatively. The mean platelet count in the second group was 67.6?22.8x109/l, to 87.8?32.1x109/l postoperatively. Concerning postoperative splenomegaly, statistically significant difference was noted between the first and the second group (p<0.05). Comparing the postoperative platelet count between the first and second group, we found that there was a very significant statistical difference, too (p<0.01). Conclusion. Distal splenorenal shunt (Warren) with partial spleen resection is a very reliable surgical technique in treatment of hypersplenism and decompression of oesophageal varices caused by portal hypertension and has advantage in treatment of hypersplenism over the distal splenorenal shunt method. .

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