Long‐term Efficacy of Distal Splenorenal Shunt with Splenopancreatic and Gastric Disconnection for Esophagogastric Varices in Patients with Idiopathic Portal Hypertension

Abstract

Idiopathic portal hypertension (IPH) requires invasive measures to prevent rupture and bleeding of esophagogastric varices. However, the long-term results of shunt surgery for IPH have not been reported. In particular, the pros and cons of surgery that preserves the spleen and its long-term hematologic effects have not been described. The records of 15 patients who underwent distal splenorenal shunt with splenopancreatic and gastric disconnection (DSRS with SPGD) for IPH between 1983 and 1998 was reviewed retrospectively. One patient died within 3 years of surgery, for a 3-year survival rate of 93%; the 10-year survival rate was 64%. Three patients (18%) suffered rebleeding from esophagogastric varices. The white blood cell and platelet counts were higher 3-5 years and 7-13 years postoperatively compared with preoperative values. Four of five patients who underwent postoperative computed tomography had a smaller spleen postoperatively. DSRS with SPGD provides long-term hemostasis for esophagogastric variceal bleeding in IPH and alleviates hypersplenism. DSRS with SPGD is an effective treatment for patients with IPH in whom long-term survival is expected.

Prognostic factors in patients with idiopathic portal hypertension: Two Japanese nationwide epidemiological surveys in 1999 and 2005

“…improved or recovered) whereas only 10% of patients had aggravated disease at a mean follow up of 6–7 years after the diagnosis. These results support the findings of previous studies that the overall prognosis of IPH was relatively favorable 3,4 …”

“…The disease often develops in the absence of cirrhosis and liver function is well preserved 1,2 . Thus, previous studies indicated that the overall prognosis of IPH is relatively favorable if variceal bleeding can be controlled 3,4 . Variceal bleeding is considered the major clinical problem caused by IPH 1,5 .…”

A Single-Institution Review of Portosystemic Shunts in Children: An Ongoing Discussion

“…In the pediatric patient population, where long-term survival is often anticipated, a splenectomy comes with significant risks and problems making preservation of the spleen highly desirable [4, 6]. In our series spleen sparing central PSS was preferred to reduce the risk of postsplenectomy sepsis, which resulted in durable patent shunts and long-term cessation of preoperative symptoms.…”

“…Many of the treatment options for symptomatic hypersplenism in the setting IHPH presented in the literature for patients with well-preserved liver function involve some type of splenorenal shunt and splenectomy [4, 6, 7]. In the pediatric patient population, where long-term survival is often anticipated, a splenectomy comes with significant risks and problems making preservation of the spleen highly desirable [4, 6].…”

Diagnosis and treatment guidelines for aberrant portal hemodynamics

“…When symptoms associated with splenomegaly (abdominal pain and compression) or a tendency to bleed and severely decreased blood cells (at least one of the following: platelets, ≤5 × 10 4 ; white blood cells, ≤3000; and red blood cells, ≤300 × 10 4 ) associated with splenomegaly, partial splenic embolization or splenectomy should be considered …”