Prophylactic surgery in non-cirrhotic portal fibrosis:is it worthwhile?
BACKGROUND
In cirrhotic patients with portal hypertension prophylactic portasystemic shunts have been found to be ineffective as deaths from post-shunt liver failure exceed those from bleeding. However, in patients with non-cirrhotic portal hypertension, variceal bleeding rather than liver failure is the common cause of death. In developing countries shortage of tertiary health-care facilities and blood banks further increases mortality due to variceal bleed.


OBJECTIVE
To study the results of prophylactic operations to prevent variceal bleeding in patients with portal hypertension due to non-cirrhotic portal fibrosis (NCPF).


METHODS
Between 1976 and 2001, we performed 45 prophylactic operations in patients with NCPF, if the patients had high-risk esophagogastric varices or symptomatic splenomegaly and hypersplenism. Proximal lienorenal shunt was done in 41 patients and the remaining underwent splenectomy with (2 patients) or without (2 patients) devascularization.


RESULTS
There was no operative mortality. Thirty-eight patients were followed up for a mean 49 (range, 12-236) months. Three patients bled - one was variceal and two due to duodenal ulcers; none died of bleeding. There were 2 late deaths (6 weeks and 10 years after surgery), one from an unknown cause and one due to chronic renal failure. The delayed morbidity was 47%. This included 7 patients who developed portasystemic encephalopathy, 4 glomerulonephritis, 2 pulmonary arteriovenous fistulae and 5 ascites requiring treatment with diuretics. Thus only 20 (53%) patients were symptom-free on follow up.


CONCLUSIONS
Prophylactic surgery is safe and effective in preventing variceal bleeding in NCPF but at the cost of high delayed morbidity.
Pal
Sujoy
S
Department of GI Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India. sujoypal@hotmail.com
Radhakrishna
P
P
Sahni
Peush
P
Pande
Girish K
GK
Nundy
Samiran
S
Chattopadhyay
Tushar K
TK
D000293:Adolescent; D000328:Adult; D002648:Child; D004932:Esophageal and Gastric Varices / Q000517:prevention & control*; D005260:Female; D005355:Fibrosis; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology* / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical; D011183:Postoperative Complications