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Indian Journal of Surgery

, Volume 81, Issue 4, pp 338–343 | Cite as

Effect of Proximal Splenorenal Shunt on Intraoperative Portal Venous Pressure and Its Correlation with Clinical Outcomes

  • Nihar Mohapatra
  • Rommel Sandhyav
  • Nikhil AgrawalEmail author
  • Asit Arora
  • Tushar Kanti Chattopadhyay
Original Article
  • 49 Downloads

Abstract

Proximal splenorenal shunt (PSRS), commonly performed for non-cirrhotic portal hypertension (NCPH), diminishes elevated portal venous pressure (PP) and prevents its sequelae. The change in PP after PSRS and its correlation with clinical outcome is largely unknown. Twenty-four patients who underwent PSRS for NCPH were evaluated prospectively. PP was measured after completion of splenectomy and after PSRS. Follow-up for 3 months was done to assess shunt patency and other relevant clinical variables. Change in PP and shunt patency were correlated with clinical outcome. Seventeen patients had extrahepatic portal vein obstruction (EHPVO) and seven had non-cirrhotic portal fibrosis (NCPF). There was a significant decrease in PP (median10 mmHg) after PSRS (p < 0.001), while decrease following splenectomy alone was not significant (p = 0.06). At 3 months, shunt patency rate was 87.5%. There was improvement in variceal grade at follow-up (p < 0.001). Change in PP did not correlate with splenic vein diameter, shunt diameter, blood flow across the shunt, shunt patency, postoperative complications, change in variceal grade, and need for endotherapy after surgery (p > 0.05). Shunt patency showed significant correlation with splenic vein diameter (p = 0.018), shunt diameter (p = 0.024), blood flow across shunt (p = 0.023), change in variceal grade (p = 0.032), and need for endotherapy (p = 0.002). PP decreases after PSRS in patients with NCPH. However, this does not correlate with clinical outcome. A patent shunt at 3 months correlated with most of these variables.

Keywords

Portal pressure Portal hypertension Proximal splenorenal shunt Extrahepatic portal vein obstruction Non-cirrhotic portal hypertension Non-cirrhotic portal fibrosis 

Notes

Acknowledgements

The authors thank Dr. Guresh Kumar and Dr. Archisman Mohapatra for their contribution in the statistical analysis of the study.

Compliance with Ethical Standards

This prospective observational study was approved by the institutional review board.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© Association of Surgeons of India 2018

Authors and Affiliations

  • Nihar Mohapatra
    • 1
  • Rommel Sandhyav
    • 2
  • Nikhil Agrawal
    • 3
    Email author
  • Asit Arora
    • 3
  • Tushar Kanti Chattopadhyay
    • 1
  1. 1.Department of HPB SurgeryInstitute of Liver and Biliary SciencesNew DelhiIndia
  2. 2.Department of Liver Transplantation and HPB SurgeryAster MedcityKochiIndia
  3. 3.Department of Surgical GastroenterologyDharamshila Narayana Superspeciality HospitalNew DelhiIndia

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