Outcomes of Proximal Spleno-Renal Shunt Operations for Idiopathic Portal Hypertension in Tertiary Hospital in the Sub-Sahara

Abstract

Purpose: Idiopathic portal hypertension (IPH) also known as non-cirrhotic portal hypertension is an entity of hepatic conditions including disorders of blood vessels that leads to portal hypertension (PHT). Current management of PHT includes medical or endoscopic therapy. A proximal spleno-renal shunt (PSRS) operation has been shown to improve the outcomes of patients with IPH with upper gastrointestinal bleeding refractory to medical and endoscopic therapy in high income countries but the same has not been well described in our resource limited setting. Patients and methods: This study consecutively included patients who were diagnosed with IPH on pre-operative imaging and underwent PSRS surgery. Data on four patients across the time period of 3 years was obtained with a male to female ratio of 1:1 and age range of 7 to 34 years. Results: All patients in this study had features of upper gastrointestinal bleeding and, after an endoscopy they were all diagnosed with grade IV esophageal varices. Symptom duration prior to admission varied between 3 months to 8 years. All these patients had multiple episodes of rebleeding varices with recurrent admissions and were managed conservatively by multiple blood transfusions and propranolol tablets, pre-operatively. Only one patient had previous variceal band ligation done though he developed rebleeding. All four patients underwent both PSRS surgery and splenectomy and were intra-operatively verified to have a normal smooth liver and thus IPH was the cause of the esophageal varices. After an average follow-up period of 26.5 months, we found that all patients were alive with early symptomatic relief, no recurrent bleeding and no long-term complications. Conclusion: Good outcomes were achieved in terms of symptom resolution, endoscopic variceal resolution at follow-up endoscopy, length of stay ranging from 8 to 15 days and all four patients were alive at the time of follow-up, that ranged from 14 to 46 months.