This work is attributed to All India Institute of Medical Sciences, New Delhi 110029. India.
Surgery as primary prophylaxis from variceal bleeding in patients with extrahepatic portal venous obstruction
Article first published online: 22 MAY 2013
© 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 28, Issue 6, pages 1010–1014, June 2013
How to Cite
Pal, S., Mangla, V., Radhakrishna, P., Sahni, P., Pande, G. K., Acharya, S. K., Chattopadhyay, T. K. and Nundy, S. (2013), Surgery as primary prophylaxis from variceal bleeding in patients with extrahepatic portal venous obstruction. Journal of Gastroenterology and Hepatology, 28: 1010–1014. doi: 10.1111/jgh.12123
No reprints will be available from the authors.
- Issue published online: 22 MAY 2013
- Article first published online: 22 MAY 2013
- Accepted manuscript online: 10 JAN 2013 12:05AM EST
- Manuscript Accepted: 2 JAN 2013
- esophageal and gastric varices;
- gastrointestinal hemorrhage;
- portal hypertension;
- portasystemic shunt;
Background and Aim
In patients with extrahepatic portal venous obstruction (EHO), death is usually due to variceal bleeding. This is more so in developing countries where there is a lack of tertiary health-care facilities and blood banks. Prophylactic operations in cirrhotics have been found to be deleterious. In contrast, patients with EHO have well-preserved liver function, and we therefore investigated the role of prophylactic surgery to prevent variceal bleeding.
Between 1976 and 2010, we operated on selected patients with EHO, who had no history of variceal bleeding but had “high-risk” esophagogastric varices or severe portal hypertensive gastropathy and/or hypersplenism, and came from remote areas with poor access to tertiary health care. Following surgery, these patients were prospectively followed up with regard to mortality, variceal bleeding, encephalopathy, and liver function.
A total of 114 patients (67 males; mean age 19 years) underwent prophylactic operations (proximal splenorenal shunts 98 [86%]; esophagogastric devascularization 16). Postoperative mortality was 0.9%. Among 89(79%) patients who were followed up (mean 60 months), hypersplenism was cured, and six (6.7%) developed variceal bleeding. The latter were managed successfully by endoscopic sclerotherapy. No patient developed overwhelming post-splenectomy sepsis or encephalopathy, and 90% were free of symptoms.
In patients with EHO, prophylactic surgery is fairly safe and prevents variceal bleeding in ∼ 94% of patients with no occurrence of portosystemic encephalopathy. Patients with EHO who have not bled but have high-risk varices and/or hypersplenism, and poor access to medical facilities should be offered prophylactic operations.