University Journal of Surgery and Surgical Specialities
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Surgery for Portal Hypertension in the Era of Tipss: Our Experience
Abstract
Background and Aim: Surgery for portal
hypertension can be either shunt surgery or the life saving
devascularisation procedures. With the advent of
interventional radiology procedures like TIPSS these are
now performed less often. We aim to analyse whether
surgery for portal hypertension does have a role in the
current era of TIPSS and endotherapy. Materials and
Methods: This is a retrospective observational study with
sample accrual done between 2012 and 2015. A total of
17 patients have undergone surgery for portal hypertension.
Among these 10 cases were having Non-cirrhotic Portal
Hypertension (NCPH) and the rest had decompensated liver
disease with portal hypertension. All the NCPH cases
underwent shunt surgeries. Devascularisation with
splenectomy was done as a life saving measure for bleeding
gastroesophageal varices with failed endotherapy in the
7 cases with cirrhosis. The age ranges of the patients were
16-42 years. The median age was 22.5 years. The indication
for surgery was analysed among these patients. The
morbidity and mortality were also analysed as primary
outcome measures. Results: 7/10 cases with NCPH had
extrahepatic portal vein obstruction. Among these 2 had
portal cavernoma cholangiopathy. 3/10 cases had NCPF.
The indication for surgery was failed endotherapy with
recurrent bleeding in 6 cases, symptomatic hypersplenism in
3 cases and symptomatic splenomegaly with large varices
and rare blood group in 1 case. All the 10 NCPH cases
underwent proximal splenorenal shunt as an elective
procedure. The indication for surgery was recurrent variceal
bleed with hemodynamic instability among the 7 patients
with DCLD related portal hypertension. The morbidity
was 40% among the NCPH group with nil mortality. There
was 80% morbidity with 2 mortality among the 7 patients
with DCLD related portal hypertension.
Conclusion: There is still a role for shunt surgeries in the era
of endotherapy in cases of NCPH as a therapeutic measure.
Devas with splenectomy is a salvage surgical procedure for
patients with portal hypertension in general, in an emergency
setting with hemodynamic instability. These surgeries have a
role especially in centres where TIPSS is not available.
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PDFReferences
Burroughs AK, editor. Methodology and review of clinical
trials in portal hypertension. Excerpta Medical Congress
Service N_ 763. Amsterdam, New York: Oxford; 1987.
de Franchis R, Pascal JP, Ancona E, Burroughs AK,
Henderson JM, Fleig W, et al. Definitions, methodology and
therapeutic strategies in portal hypertension. A consensus
development workshop. J Hepatol 1992;15: 256–261.
de Franchis R. Developing consensus in portal
hypertension. J Hepatol 1996;25:390–394.
de Franchis R, editor. Portal Hypertension II. Proceedings
of the second Baveno international consensus workshop on
definitions, methodology and therapeutic strategies. Oxford:
Blackwell Science; 1996.
Spina GP, Arcidiacono R, Bosch J, Pagliaro L, Burroughs
AK, Santambrogio R, et al. Gastric endoscopic features in
portal hypertension: final report of a consensus conference.
J Hepatol 1994;21:461–467.
Grace ND, Groszmann RJ, Garcia-Tsao G, Burroughs AK,
Pagliaro L, Makuch RW, et al. Portal hypertension and
variceal bleeding: an AASLD single topic symposium.
Hepatology 1998;28:868–880.
de Franchis R. Updating consensus in portal
hypertension: report of the Baveno III consensus workshop
on definitions, methodology and therapeutic strategies in
portal hypertension. J Hepatol 2000;33:846–852.
de Franchis R, editor. Portal Hypertension III. Proceedings
of the IIIrd Baveno International Consensus Workshop on
Definitions, Methodology and Therapeutic Strategies.
Oxford, UK: Blackwell Science; 2001.
de Franchis R. Evolving consensus in portal
hypertension. Report of the Baveno IV consensus workshop
on methodology of diagnosis and therapy in portal
hypertension. J Hepatol 2005;43:167–176.
de Franchis R, editor. Portal Hypertension IV.
Proceedings of the IVth Baveno international consensus
workshop on methodology of diagnosis and treatment.
Oxford, UK: Blackwell Publishing; 2006.
Garcia-Tsao G, Bosch J, Groszmann R. Portal
hypertension and variceal bleeding, unresolved issues.
Summary of an American Association for the study of liver
disease and of the European Association for the Study of the
Liver single-topic conference. Hepatology 2008;47:
–1772.
de Franchis Ron behalf of the Baveno V Faculty. Report
of the Baveno V consensus workshop on methodology of
diagnosis and therapy in portal hypertension. J Hepatol
;53:762–768.
de Franchis R, editor. Portal Hypertension V.
Proceedings of the Vth Baveno international consensus
workshop. Oxford, UK: Wiley-Blackwell; 2011.
J. Michael Henderson, Thomas D. Boyer, Michael H.
Kutner, John R. Galloway,Layton F. Rikkers, Lennox J.
Jeffers, Distal Splenorenal Shunt Versus Transjugular
Intrahepatic Portal Systematic Shunt for Variceal Bleeding:
A Randomized Trial. GASTROENTEROLOGY
;130:1643 -1651.
Rosemurgy AS, Serafini FM, Zweibel BR, Black TJ,
Kudryk BT, Nord HR, et al. Transjugular intrahepatic
portosystemic shunt vs. small-diameter prosthetic H-graft
portacaval shunt: extended follow-up of an expanded
randomized prospective trial. J Gastroinest Surg 2000;4:
–597.
Non-cirrhotic portal hypertension-Diagnosis and
management Khanna, Rajeev et al. Journal of Hepatology,
Volume 60, Issue 2 , 421 - 441.
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