Proximal splenoadrenorenal shunt: a safe and effective alternative in non cirrhotic portal hypertension

Abstract

Introduction: Proximal splenorenal shunt (PSRS) is an established option in the management of Non cirrhotic portal hypertension (NCPH) including Extrahepatic portal vein obstruction (EHPVO) and Non cirrhotic portal fibrosis (NCPF).An end to end splenoadrenal shunt (PSARS) has been selectively used at our centre instead of PSRS with the potential advantage of better reach and the avoidance of looping and/or clamping the main left renal vein. We sought to review our experience with PSARS and their outcomes. Methods: Retrospective analysis of consecutive cases of PSARS done between January 2010 and January 2015 from a prospectively maintained database. Demography, preoperative indications, hematologic, endoscopic and Doppler findings, intraoperative data and postoperative outcomes were recorded. Results: Seventeen patients who underwent PSARS formed the study group (12 -EHPVO; 5 -NCPF). Median (range) age of patients was 18 (7–40) years. Bleed was the most common indication seen in 13 (76.5%) patients. Three of 13 patients with hypersplenism were symptomatic; while only 1 out of 8 patients was symptomatic for portal biliopathy. Median (range) adrenal vein size was 6 (4–8) mm. Median (range) intraoperative blood loss was 80 (50–500) ml. Postoperatively 1 patient underwent reexploration for intraabdominal bleed with no perioperative mortality in any of the patients. All patients showed improvement in pancytopenia. Variceal grade decreased in 14 (82.4%) patients with no subsequent rebleed at a median follow up of 32 (8–48) months. Conclusion: PSARS is a good alternative to PSRS in NCPH when the adrenal vein diameter is reasonable.