Portal biliopathy in patients with non-cirrhotic portal hypertension: does the type of surgery affect outcome?

Abstract

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.

Endoscopic Management of Portal Cavernoma Cholangiopathy: Practice, Principles and Strategy

“…Benefits from PSS include regression of changes seen in early cholangiopathy, 35,36 complete regression of biliary obstruction in about 60-88% of patients 11,19,20,35,37 with further interventions needed for persistent biliary obstruction in only 25-30%. 20 The remaining patients usually remain asymptomatic, even though regression of cholangiographic changes is incomplete, suggesting arrest or slowing-down of progression after PSS.…”

Surgical Management of Portal Cavernoma Cholangiopathy

“…One of the strong arguments in favor of operative management has been the fact that surgery is a onetime procedure, does not require repeated hospital visits, which is particularly relevant for the majority of EHPVO patients who come from areas where specialized medical help and access to endotherapy may not be available. 11 In many surgical series, there are a group of about 20-47% of patients who are deemed as nonshuntable due to a lack of any suitable veins. This is because the entire portal venous system is obliterated and replaced by extensive collaterals.…”

“…Chattopadhyay et al reported that patients who underwent these nonshunt procedures also had a significant reduction in their serum bilirubin levels. 11 Splenic artery ligation leads to reduction in the portal blood flow and portal pressure, which may lower the pressure in the pericholedochal collaterals leading to symptomatic improvement in PCC.…”

“…In this group it has been an observation by some that splenectomy devascularization alone will not only take care of the variceal bleed and hypersplenism but would also reduce the pressure in the pericholedochal collaterals (decreases the portal inflow as well as pressure) and might help in those having symptomatic PCC. 11 The other rare surgical option for these patients having EHPVO and PCC is liver transplant. [21][22][23] This option is applicable only for those patients who are troubled more by the PCC than hypersplenism or variceal bleed.…”

“…However there is a small group (28-50%) of patients in whom PCC is not relieved after a shunt procedure and these will need drainage to reverse their biliary obstruction either via a stent or a surgical drainage procedure like a hepaticojejunostomy. [7][8][9][10][11] These patients present late in life and have usually had repeated episodes of cholangitis and stent exchanges. 2-4% of patients in whom the biliary obstruction has been present for a long time may go on to develop secondary biliary cirrhosis.…”