Portal biliopathy in patients with non-cirrhotic portal hypertension: does the type of surgery affect outcome?
OBJECTIVE
After portosystemic anastomoses for biliopathy, some patients continue to suffer biliary obstruction. The effects of splenectomy and devascularization of the abdominal oesophagus and upper stomach are unclear. The aim of the current study was to determine the features of portal biliopathy (PB) in patients with non-cirrhotic portal hypertension, and to investigate outcomes in these patients after surgical procedures.


METHODS
A retrospective study of 56 patients who underwent surgery for PB during 1996-2010 was conducted. Data on presenting features, treatment received and outcomes were analysed.


RESULTS
In total, 41 of these patients had extrahepatic portal venous obstruction and 15 had non-cirrhotic portal fibrosis. Forty patients underwent shunt surgery and 16 underwent splenectomy and devascularization. Median bilirubin levels fell from 1.8 mg/dl (range: 0.4-5.9 mg/dl) to 1.0 mg/dl (range: 0.3-5.4 mg/dl) after shunt surgery and from 1.9 mg/dl (range: 0.6-4.0 mg/dl) to 1.2 mg/dl (range: 0.6-5.2 mg/dl) after splenectomy-devascularization. On follow-up, five of 33 patients had persistent jaundice after successful shunt surgery. These patients had a history of multiple endoscopic stentings and three patients had demonstrated a dominant common bile duct stricture preoperatively.


CONCLUSIONS
Portal biliopathy was reversed in 38 of 43 patients by either portosystemic shunting or splenectomy-devascularization. In five patients, direct biliary decompressive procedures were required because of shunt blockage or a non-reversible biliary stricture.
Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India. doc.somnath@gmail.com
Somnath
S
Chattopadhyay
Mahendran
M
Govindasamy
Punit
P
Singla
Vibha
V
Varma
Naimish
N
Mehta
Vinay
V
Kumaran
Samiran
S
Nundy
D000293:Adolescent; D000328:Adult; D001660:Biliary Tract Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D019299:Decompression, Surgical / Q000295:instrumentation; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007194:India; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects; D012189:Retrospective Studies; D013156:Splenectomy / Q000009:adverse effects; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult
D015415:Biomarkers; D001663:Bilirubin