Use of caudal pancreatectomy as a novel adjunct procedure to proximal splenorenal shunt in patients with noncirrhotic portal hypertension: A retrospective cohort study

Abstract

Proximal splenorenal shunt (PSRS) is considered a one-time treatment for noncirrhotic portal hypertension (NCPH) to prevent recurrent upper gastrointestinal (UGI) hemorrhage and long-term complications. Long-term shunt patency is necessary to achieve these. The lie of the shunt is a contributing factor to early shunt thrombosis. We investigated the role of resection of the distal tail of pancreas (caudal pancreatectomy [CP]) in improving the lie of shunt and decreasing shunt thrombosis. Methods: This was a retrospective cohort study of patients with NCPH who underwent PSRS between 2014-2020 in JIPMER, Puducherry, India. CP was performed in patients with a long tail of pancreas, with the tip of pancreatic tail extending up to splenic hilum on preoperative CT. Perioperative parameters and shunt patency rate of patients who underwent PSRS with CP (Group A) were compared with patients undergoing conventional PSRS (Group B). Statistical analysis was performed using the Mann-Whitney U test and χ 2 test.Results: Eighty four patients with NCPH underwent PSRS (extrahepatic portal vein obstruction = 39; noncirrhotic portal fibrosis = 45). Blood loss was lower (p = 0.002) and post-shunt fall in portal pressure higher (p = 0.002) in Group A. Shunt thrombosis rate was lower (p = 0.04) while rate of complete variceal regression (p = 0.03) and biochemical pancreatic leak (p = 0.01) were higher in Group A.There was no clinically relevant pancreatic fistula in either group. Conclusions: CP is a safe and useful technique for reducing shunt thrombosis after PSRS in patients with NCPH by improving the lie of shunt.

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

“…The later study further revealed a complete shunt patency rate of 100%, with no instances of shunt thrombosis, re-intervention for variceal bleeding, or mortality. According to the study by Gupta et al (2022), a success rate of 88% was seen over the follow-up period, with no reported cases of thrombosis development. Comparable results were also documented in another study that was reviewed in this research.…”

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

“…Shunt thrombosis is one of the important post PSS complications, seen in nearly 5.6%-47% of cases [36,52,53]. In early postoperative period, probable causes of shunt thrombosis are small diameter shunt, poor SV backflow, improper lie, pathological SV wall, and difficulty in anastomosis; whereas at late phase, procoagulant disorder and post-splenectomy thrombocytosis play important negative role [52,[54][55][56][57]. According to Bismuth, to avoid thrombosis, the shunt size should be > 10 mm [58], though in paediatric group of patients, it is often not feasible, and shunt size > 4 mm may show a good patency rate of 84%−96% [30].…”