<p>Combination of modified Sugiura technique and proximal splenorenal shunt for the management of portal vein thrombosis in noncirrhotic portal hypertension</p>

Abstract

Background: Noncirrhotic portal hypertension (NCPH) is a condition when a high hepatic venous pressure gradient with preserved liver functions and the absence of parenchymal dysfunction. NCPH with portal vein thrombosis (PVT) is a rare condition. Surgery aims to reduce portal vein flow and alter portal vein circulation. Case: A male, 59 years old, complained of blackish stool in the last 2 weeks and enlarged abdomen. Physical examination revealed anemia and melena with splenomegaly and ascites. Laboratory findings were anemia, normal hepatobiliary function, and no liver infection. Abdominal Doppler ultrasonography and contrast-enhanced abdominal computed tomography scan revealed ascites, splenomegaly, noncirrhotic liver, dilatation of portal vein, low portal vein peak velocity, and PVT. Esophagogastroduodenoscopy revealed esophageal varices grade 3 with a positive red color sign and cardia stomach varices. We performed a modified Sugiura technique through the left subcostal incision and proximal splenorenal shunt. The procedures of the modified Sugiura technique are splenectomy, devascularization, transection, and end-to-end anastomosis of the lower esophagus above the gastroesophageal junction, devascularization of the upper 2/3 of the lesser and greater curvatures of the stomach, and pyloroplasty. Portal circulation alteration used the proximal splenorenal shunt with end-to-side anastomosis of the splenic vein to left renal vein. At the one-year follow-up after surgery, his physical condition was better and there was no sign of complications. Conclusion: Devascularization procedure using a modified Sugiura technique is useful to treat and avoid rupture of esophageal varices. Portal circulation alteration using the proximal splenorenal shunt is a good choice. The treatment in NCPH utilizing the combination of modified Sugiura technique and the proximal splenorenal shunt is proper without complication.

Laparoscopic splenectomy and proximal splenorenal shunt for portal hypertension due to portal vein thrombosis in a patient with protein S deficiency

“…Irawan and Mulyawan described a combination of modified Sugiura technique and proximal splenorenal shunt for reducing portal vein flow in a 59-year-old man with noncirrhotic portal hypertension due to portal vein thrombosis, who presented to the emergency department with upper gastrointestinal bleeding. After the procedure, the patient also evidenced improvement in physical condition and had no complications (12) . Anand et al, reported 25 cases of proximal splenorenal shunt in non-cirrhotic portal hypertension for management of gastric variceal hemorrhage.…”

Efficacy, Safety, and Clinical Outcomes of Splenorenal Shunt Surgery as a Therapeutic Intervention for Portal Hypertension Patients

“…A combination of a modified surgical technique with proximal splenorenal shunts has also been discovered as an advantageous therapeutic approach for managing portal vein thrombosis in patients with non-cirrhotic portal hypertension. This treatment strategy has demonstrated efficacy in preventing rebleeding, as supported by studies conducted by Gupta et al (2019), Irawan &Mulyawan (2019), andTerwagne et al (2022).…”

A success story of modified Sugiura technique surgery in a non-cirrhotic portal hypertension (NCPH)

“…The modified Sugiura technique is a one-stage transabdominal approach that is used to achieve extensive gastroesophageal devascularization. 32, 33 The total operation time is an average of 5 h. In patients with cirrhosis, Sugiura procedure result in a lower incidence of postoperative encephalopathy and better quality of life with prolonged survival compared to TIPS. 34 The report of Sugiura procedure performed on NCPH patients is limited, and in our patient, this procedure results favorable clinical improvement in a NCPH patient that was refractory to medical treatment and endoscopic ligation.…”