Surgical management in portal hypertension

Background: Portal hypertension commonly accompanies cirrhosis of liver and is a consequence of an increase in splanchnic blood flow secondary to vasodilatation and increased resistance to the passage of blood through the cirrhotic liver. Development of oesophageal varices (OV) is one of the major complications of portal hypertension. In present study we attempted to compare different surgical modalities in case of Portal Hypertension (PHT) by their indications, contraindications, complications and outcomes in a group of 50 patients. Aim and objectives: To study the indications, contraindications, complications and outcomes in different decompressive shunt procedure and devascularisation procedure, to discuss the advantages and disadvantages of different surgical procedures in case of portal hypertension, to discuss role of shunt surgery in modern era of liver transplantation. Materials and methods: During our work period from June 2008 to November 2010, all patient admitted in our institution were considered for study. Detailed history was elicited in each case. Various symptoms were noted and a detailed general, systemic and local examination was done in cases. Various operative surgery was done in the form of Distal Spleenorenal Shunt, Spleenectomy with Devascularisation, Side to Side Mesocaval Shunt, side to side lineorenal Shunt. All the patients were observed for post operative complications and managed accordingly. Regular follow up of patient was conducted till date. All the case was studied on the basis of following proforma. Results: All patients were advised surgery. Out of this only 1 (2.56%) mortality were found which was with the DSRS. All patients with Child's Criteria B were selected for side to side portocaval shunt of which there was no mortality, in all patients with Child's Criteria A in whom different surgical modalities were conducted have 3.12% mortality with DSRS and associated morbidity variceal bleeding, total rebleeding and shunt occlusion in both groups. Variceal bleeding was found in 2 cases of which 50% was with Grade A and 50% was with Grade B of Child's Criteria. Total rebleeding was found in only 1 (3.12%) patient with Child's Criteria Grade A. Shunt occlusion was found in only 1 (3.12%) patient with Child's Criteria Grade A. Encephalopathy was found in 5 (12.82%) patients out of which 4 (57.14%) patients were with Child's Criteria Grade B, and only 1 (3.12%) patient with Child's Criteria Grade A. Conclusion: More studies are needed to established any conclusion as there are some shortcomings like; patients are lost in follow up, liver transplantation is yet in developmental stage and scarcity of grafts in government setup.