Effect of shunt surgery on spleen size, portal pressure and oesophageal varices in patients with non-cirrhotic portal hypertension.

Abstract

Shunt surgery is considered to be the treatment of choice in patients with non-cirrhotic portal hypertension. There is little data on the effect of side-to-side lieno-renal (SSLR) shunt on oesophageal variceal size, splenic size and splenic pulp pressure (SPP) in patents with non-cirrhotic portal hypertension. We evaluated pre- and postoperatively endoscopic grading of varices, splenic size and SPP for predicting shunt patency in 86 patients with non-cirrhotic portal hypertension: 56 with extrahepatic portal venous obstruction (EHPVO) and 30 with non-cirrhotic portal fibrosis (NCPF). The EHPVO patients with patent shunts (n = 47) showed significant reduction in SPP (pre-operative 43.56 +/- 7.9 vs postoperative 29.96 +/- 0.5 vs 0.92 +/- 0.8). Patients with blocked shunt (n = 9) did not show significant reduction in SPP and varices grades. However, there was reduction in spleen size (8.6 +/- 3.0 vs 6.3 +/- 4.3). In the NCPF group, 28 had patent shunts and showed significant reduction in SPP (46.3 +/- 13.5 vs 33.8 +/- 7.6 cm of saline), splenic size (9.1 +/- 3.3 vs 6.8 +/- 4.6 cm below costal margin) and varices grades (2.8 +/- 0.7 vs 1.05 +/- 0.96). As only two patients with NCPF had blocked shunts, no statistical comparison between patients with patent and patients with blocked shunts could be done. In conclusion, following SSLR, there is a significant reduction in SPP and varices grades in patients with patent shunts. Endoscopic grading of varices can be used to predict shunt patency. However, spleen size is not a good criteria for predicting shunt patency.