Surgical outcome of extrahepatic portal venous obstruction: Audit from a tertiary referral centre in Eastern India

Somak Das; Tuhin Subhra Manadal; Suman Das; Jayanta Biswas; Arunesh Gupta; Sreecheta Mukherjee; Sukanta Ray

doi:10.14701/ahbps.23-025

Ann Hepatobiliary Pancreat Surg 2023 Nov;27(4):350-65

Published online November 30, 2023; https://doi.org/10.14701/ahbps.23-025

Somak Das, Tuhin Subhra Manadal, Suman Das, Jayanta Biswas, Arunesh Gupta, Sreecheta Mukherjee, Sukanta Ray

Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, India

Correspondence to: Somak Das, MS, DNB
Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata 700020, India
Tel: +91-9433117399, Fax: +91-3322235435, E-mail: d.somak@yahoo.com
ORCID: https://orcid.org/0000-0002-7066-2128

Received March 3, 2023; Revised April 11, 2023; Accepted April 17, 2023.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract: Backgrounds/Aims: Extra hepatic portal venous obstruction (EHPVO) is the most common cause of portal hypertension in Indian children. While endoscopy is the primary modality of management, a subset of patients require surgery. This study aims to report the short- and long-term outcomes of EHPVO patients managed surgically.
Methods: All the patients with EHPVO who underwent surgery between August 2007 and December 2021 were retrospectively reviewed. Postoperative complications were classified after Clavien–Dindo. Binary logistic regression in Wald methodology was used to determine the predictive factors responsible for unfavourable outcome.
Results: Total of 202 patients with EHPVO were operated. Mean age of patients was 20.30 ± 9.96 years, and duration of illness, 90.05 ± 75.13 months. Most common indication for surgery was portal biliopathy (n = 59, 29.2%), followed by bleeding (n = 50, 24.8%). Total of 166 patients (82.2%) had shunt procedure. Splenectomy with esophagogastric devascularization was the second most common surgery (n = 20, 9.9%). Nine major postoperative complications (Clavien–Dindo > 3) were observed in 8 patients (4.0%), including 1 (0.5%) operative death. After a median follow-up of 56 months (15−156 months), 166 patients (82.2%) had favourable outcome. In multivariate analysis, associated splenic artery aneurysm (p = 0.007), isolated gastric varices (p = 0.004), preoperative endoscopic retrograde cholangiography and stenting (p = 0.015), and shunt occlusion (p < 0.001) were independent predictors of unfavourable long-term outcome.
Conclusions: Surgery in EHPVO is safe, affords excellent short- and long-term outcome in patients with symptomatic EHPVO, and may be considered for secondary prophylaxis.; Keywords : Extrahepatic portal venous obstruction; Portal biliopathy; Variceal bleeding; Proximal splenorenal shunt; Splenectomy and esophagogastric devascularisation