OUTCOMES OF PROXIMAL SPLENORENAL SHUNT SURGERY IN EXTRA HEPATIC PORTAL VEIN OBSTRUCTION (EHPVO) – EXPERIENCE FROM A TERTIARY CENTER IN GUJARAT, INDIA.

Abstract

Background – Extra hepatic portal vein obstruction commonly presents with variceal bleeding and splenomegaly. Management with endoscopic means provide temporary palliation. A proximal splenorenal shunt is a denitive procedure with good results. Our aim was to evaluate the outcomes of splenectomy with proximal splenorenal shunt in patients with extrahepatic portal venous obstruction. Methods – The records of all patients with diagnosis of EHPVO who were operated for splenectomy with proximal splenorenal shunt during the period from January 2014 to august 2018 were analysed. Total of 34 patients with EHPVO were operated for splenectomy with proximal splenorenal shunt over the study period. Outcomes were evaluated in term of rebleeding, variceal regression shunt thrombosis and post shunt encephalopathy. Results – All the patients were below 30 years age. Shunt surgery lead to reversal of various degree of cytopenias and hypersplenism. Variceal regression was seen from large size (grade III and IV) to small size (grade II) in 74% of patients. We had low incidence of shunt block (5.88%), variceal rebleeding (2.94%) and no mortality. None of the patients developed encephalopathy during follow-up. Conclusion- Splenectomy with proximal splenorenal shunt is a single time safe procedure, with low morbidity and mortality; having low rates of variceal rebleeding and encephalopathy; with low cost in teaching hospital, thus can be considered as the main treatment approach in patients with EHPVO.