Splenectomy with endotherapy in non-cirrhotic portal fibrosis related portal hypertension: Can it be an alternative to proximal spleno-renal shunt?

Sundeep Singh Saluja; Ajay Kumar; Hari Govind; Vaibhav Kumar Varshney; Rahul Khullar; Pramod Kumar Mishra

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자료유형: 학술저널

저자정보: Sundeep Singh Saluja (Govind Ballabh Pant Institute of Post Graduate Medical Education and Research) Ajay Kumar (Govind Ballabh Pant Institute of Post Graduate Medical Education and Research) Hari Govind (Govind Ballabh Pant Institute of Post Graduate Medical Education and Research) Vaibhav Kumar Varshney (Govind Ballabh Pant Institute of Post Graduate Medical Education and Research) Rahul Khullar (Govind Ballabh Pant Institute of Post Graduate Medical Education and Research) Pramod Kumar Mishra (Govind Ballabh Pant Institute of Post Graduate Medical Education and Research)

저널정보: 한국간담췌외과학회 Annals of Hepato-Biliary-Pancreatic Surgery 한국간담췌외과학회지 제24권 제2호

발행연도: 2020.5

수록면: 168 - 173 (6page)

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Backgrounds/Aims: Proximal splenorenal shunt (PSRS) is usually done in symptomatic non-cirrhotic portal fibrosis (NCPF). The outcomes of splenectomy with endotherapy in non-bleeder NCPF patients has not been well studied. We here by aimed to study the post-surgical outcomes on short and long-term basis between PSRS and splenectomy among non-bleeder NCPF patients. Methods: The consecutive non-bleeder NCPF patients whom underwent either splenectomy or PSRS from 2008 to 2016 were enrolled. The patients were followed up post-surgery clinically and biochemical investigations, Doppler ultrasound and upper gastrointestinal endoscopy were done as required. The peri-operative parameters compared were operative time, blood loss, hospital stay and morbidity. The long-term outcome measures compared were incidence of portal hypertension (PHTN) related bleed, change in grade of varices, shunt patency, shunt complications and thrombosis of spleno-portal axis. Results: Among 40 patients with non-bleeder status, 24 underwent splenectomy and 16 underwent PSRS. The baseline characteristics including indication of surgery, biochemical investigations and grade of varices were comparable between PSRS and splenectomy. The peri-operative morbidity was not significantly different between two groups. The median follow up duration was 42 months (12-72 months), the decrement in grade of varices was significantly higher in PSRS group (p=0.03), symptomatic PHTN related UGIB was non-significant between PSRS and splenectomy (p=0.5). In PSRS group, 3 (18.3%) patients had shunt thrombosis (n=1) & encephalopathy (n=2) while in splenectomy group two patients developed thrombosis of splenoportal axis. Conclusions: Splenectomy with endotherapy is alternative to PSRS in non-bleeder NCPF patients with indications for surgery.

#Non-cirrhotic portal fibrosis #GI bleed #Spleno-renal shunt #Splenectomy #Endotherapy

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