Surgical Management of Non-Cirrhotic Portal Hypertension: An Experience from a Specialized Hepatopancreatobiliary Centre

Abstract

Introduction: Extrahepatic portal vein obstruction is one of the common causes of portal hypertension in non-cirrhotic patients. The sequelae of portal hypertension are hematemesis, portal gastropathy, hypersplenism, and growth retardation. Although advances in endoscopic and radiological interventions effectively manage the complications, only surgery still provides the single-step solution for portal hypertension and its associated complications. The objective of this study was to evaluate and share our experience of surgical management in patients presented with portal vein thrombosis. Methods: Patients from February 2019 to June 2023 who underwent surgery related to portal vein thrombosis were retrospectively reviewed. Data collected included clinical presentation, etiological features, associated complications, a surgical procedure performed, postoperative complications, and recurrence rate were evaluated. Results: 45 patients (median Age: 26 ± 11 years) underwent surgical procedures during this study period. A proximal splenorenal shunt was formed in 36 patients, and in 09 patients, splenectomy and devascularization surgery were performed. Complications developed during the postoperative course were abdominal collection, DVT, cholangitis, chyle leak, and hematemesis. All these complications were managed non-operatively. Only two patients had a single upper gastrointestinal bleeding episode managed conservatively with no further recurrence of symptoms. During a long-term follow-up of 5 years, only one patient presented with a recurrence of symptoms. Conclusion: Extrahepatic portal vein obstruction is one of the common causes of portal hypertension. Although endoscopic and radiological interventions have played a very influential role in managing these complications, surgery is still an effective one-time option with no significant morbidity or mortality.