Porto Systemic Shunt Surgery - Case Series of 40 Cases Performed at a Single Tertiary Care Centre

Abstract

Introduction: Portal hypertension is seen when there is pathological increase in hepatic venous pressure gradient. Portal hypertension is seen in a number of conditions like extra-hepatic portal venous obstruction, cirrhosis of liver, non cirrhotic portal fibrosis, portal vein thrombosis from various causes. Surgical Porto systemic shunts are a time proven modality for treating portal hypertension. These patients present as recurrent variceal bleeding, ascites, encephalopathy. This is a case series on Porto systemic shunting done in patients in a single tertiary care centre. Method: Retrospective study of 40 cases performed in a single tertiary care centre performed over 5 years from 2012 to 2016, along with comparison with the existing data on Porto systemic shunt surgeries. Results: From amongst the 40 patients cases of extra-hepatic portal venous obstruction were 75%, non cirrhotic portal fibrosis were 15%, portal vein thrombosis were 5%, cirrhotic patients were 5%. There was no immediate peri-operative mortality. 4 year shunt patency was 97%. Recurrent variceal bleeding was seen in 5%. Encephalopathy was seen in 1%. Re-intervention was required in 3%. 4 year survival was 96%. Conclusions: Surgical Porto systemic shunts remain time tested efficacious modality in management of portal hypertension. Porto systemic shunts have good long term survival benefit with symptomatic relief and improvement of quality of life.