Use of caudal pancreatectomy as a novel adjunct procedure to proximal splenorenal shunt in patients with noncirrhotic portal hypertension: A retrospective cohort study

Shahana Gupta; Biju Pottakkat; Raja Kalayarasan; Gnanasekaran Senthil; Pagadala Naga Balaji Nitesh

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자료유형: 학술저널

저자정보: Shahana Gupta (Jawaharlal Institute of Postgraduate Medical Education and Research) Biju Pottakkat (Jawaharlal Institute of Postgraduate Medical Education and Research) Raja Kalayarasan (Jawaharlal Institute of Postgraduate Medical Education and Research) Gnanasekaran Senthil (Jawaharlal Institute of Postgraduate Medical Education and Research) Pagadala Naga Balaji Nitesh (Jawaharlal Institute of Postgraduate Medical Education and Research)

저널정보: 한국간담췌외과학회 Annals of Hepato-Biliary-Pancreatic Surgery 한국간담췌외과학회지 제26권 제2호

발행연도: 2022.5

수록면: 178 - 183 (6page)

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Backgrounds/Aims: Proximal splenorenal shunt (PSRS) is considered a one-time treatment for noncirrhotic portal hypertension (NCPH) to prevent recurrent upper gastrointestinal (UGI) hemorrhage and long-term complications. Long-term shunt patency is necessary to achieve these. The lie of the shunt is a contributing factor to early shunt thrombosis. We investigated the role of resection of the distal tail of pancreas (caudal pancreatectomy [CP]) in improving the lie of shunt and decreasing shunt thrombosis.
Methods: This was a retrospective cohort study of patients with NCPH who underwent PSRS between 2014–2020 in JIPMER, Puducherry, India. CP was performed in patients with a long tail of pancreas, with the tip of pancreatic tail extending up to splenic hilum on preoperative CT. Perioperative parameters and shunt patency rate of patients who underwent PSRS with CP (Group A) were compared with patients undergoing conventional PSRS (Group B). Statistical analysis was performed using the Mann–Whitney U test and χ² test.
Results: Eighty four patients with NCPH underwent PSRS (extrahepatic portal vein obstruction = 39; noncirrhotic portal fibrosis = 45). Blood loss was lower (p = 0.002) and post-shunt fall in portal pressure higher (p = 0.002) in Group A. Shunt thrombosis rate was lower (p = 0.04) while rate of complete variceal regression (p = 0.03) and biochemical pancreatic leak (p = 0.01) were higher in Group A.There was no clinically relevant pancreatic fistula in either group.
Conclusions: CP is a safe and useful technique for reducing shunt thrombosis after PSRS in patients with NCPH by improving the lie of shunt.

#Caudal pancreatectomy #Noncirrhotic portal hypertension #Proximal splenorenal shunt #Lie of the shunt #Shunt thrombosis

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