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Surgery as primary prophylaxis from variceal bleeding in patients with extrahepatic portal venous obstruction.
MedLine Citation:
PMID:  23301629     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: In patients with extrahepatic portal venous obstruction (EHO), death is usually due to variceal bleeding. This is more so in developing countries where there are a lack of tertiary healthcare facilities and blood banks. Prophylactic operations in cirrhotics have been found to be deleterious. In contrast, patients with EHO have well preserved liver function and we therefore investigated the role of prophylactic surgery to prevent variceal bleeding. METHODS: Between 1976 and 2010, we operated on selected patients with EHO, who had no history of variceal bleeding but had 'high risk' oesophagogastric varices or severe portal hypertensive gastropathy, and/or hypersplenism and came from remote areas with poor access to tertiary healthcare. Following surgery these patients were prospectively followed up with regard to mortality, variceal bleeding, encephalopathy and liver function. RESULTS: A total of 114 patients (67 males; mean age: 19 years) underwent prophylactic operations [proximal splenorenal shunts: 98(86%); oesophagogastric devascularization: 16]. Postoperative mortality was 0.9%. Among 89(79%) patients who were followed up (mean: 60 months), hypersplenism was cured and 6 (6.7%) developed variceal bleeding. The later were managed successfully by endoscopic sclerotherapy. No patient developed overwhelming post-splenectomy sepsis or encephalopathy and 90% were free of symptoms. CONCLUSION: In patients with EHO, prophylactic surgery is fairly safe and prevents variceal bleeding in ∼ 94% of patients with no occurrence of portosystemic encephalopathy. Patients with EHO who have not bled but have high-risk varices and/or hypersplenism and poor access to medical facilities should be offered prophylactic operations.
Authors:
Sujoy Pal; Vivek Mangla; Patta Radhakrishna; Peush Sahni; Girish Kumar Pande; Subrat Kumar Acharya; Tushar Kanti Chattopadhyay; Samiran Nundy
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-10
Journal Detail:
Title:  Journal of gastroenterology and hepatology     Volume:  -     ISSN:  1440-1746     ISO Abbreviation:  J. Gastroenterol. Hepatol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607909     Medline TA:  J Gastroenterol Hepatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.
Affiliation:
Department of GI Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, 110029, India.
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