Abstract
Backgrounds/Aims
Methods
Results
ACKNOWLEDGEMENTS
REFERENCES
Table 1
EHPVO, extra hepatic portal venous obstruction; PRBC, packed red blood cell; EST, endoscopic sclerotherapy; EVL, esophageal varix; ERC, endoscopic retrograde cholangiography; PTBD, percutaneous trans-hepatic biliary drainage; TLC, total leukocyte count; INR, international normalized ratio; AST, aspartate aminotransferase; ALT, alanine transaminase; USG, ultrasonography; CECT, contrast enhanced computed tomography; MRCP, magnetic resonance cholangiopancreatography.
Table 2
Table 3
Table 4
Follow-up parameter | Value |
---|---|
Duration of follow-up (mon) | 56 (15–156) |
Rebleeding | 6 (3.0) |
Follow up endoscopy (n = 54) | |
Normal | 42 (77.8) |
Esophageal varices | 7 (13.0) |
GOV | 2 (3.7) |
IGV | 1 (1.9) |
PHG | 1 (1.9) |
Ulcer | 1 (1.9) |
Shunt patency (n = 166) | 155 (93.4) |
Subsequent surgery | |
Not required | 185 (91.6) |
Devascularization | 1 (0.5) |
Mesocaval shunt | 1 (0.5) |
Open cholecystectomy | 2 (1) |
Laparoscopic cholecystectomy | 3 (1.5) |
Hepaticojejunostomy | 6 (3.0) |
Others | 1 (0.5) |
Bleeding during subsequent surgery (mL) (n = 14) | 477.27 ± 278.71 |
Blood transfusion in subsequent surgery (units of PRBC) (n = 10) | 1.50 ± 1.43 |
Outcome (n = 194) | |
Asymptomatic | 166 (85.6) |
Non-bleeder varices requiring endotherapy | 8 (4.1) |
Rebleeding requiring endotherapy | 4 (2.1) |
Rebleeding requiring surgery | 1 (0.5) |
Portal bilioparty requiring ERC | 10 (5.2) |
Portal biliopathy requiring HJ | 5 (2.6) |
Overall mortality | |
Operative death, 90-day mortality = 1 (0.5)a) | 8 (4.0) |
Table 5
Parameter | Univariate analysis | Multivariate analysis | ||||
---|---|---|---|---|---|---|
Favourable long-term outcome (n = 166) | Unfavourable long-term outcome (n = 28) | p-value | Exp (B) (OR) | p-value (95% CI) | ||
Age (yr) | 19.32 ± 9.86 | 22.93 ± 9.01 | 0.71 | |||
Sex | > 0.999 | |||||
Male (n = 88) | 75 (85.2) | 13 (14.8) | ||||
Female (n = 106) | 91 (85.8) | 15 (14.2) | ||||
Age of onset (yr) | 12.33 ± 10.64 | 14.45 ± 10.46 | 0.33 | |||
Index presentation | 0.57 | |||||
Bleeding (n = 160) | 136 (85.0) | 24 (15.0) | ||||
Portal biliopathy (n = 15) | 12 (80.0) | 3 (20.0) | ||||
Biliary lithiasis (n = 5) | 4 (80.0) | 1 (20.0) | ||||
Symptomatic splenomegaly (n = 9) | 9 (100) | 0 | ||||
Symptomatic hypersplenism (n = 5) | 5 (100) | 0 | ||||
Duration of illness (mon) | 84.94 ± 67.55 | 102.25 ± 89.86 | 0.235 | |||
Bleeding episodes | 3.78 ± 6.16 | 5.32 ± 8.18 | 0.244 | |||
No. of blood transfusions | 5.86 ± 9.54 | 8.29 ± 12.43 | 0.237 | |||
No. of endoscopy | 9.32 ± 8.74 | 9.93 ± 10.38 | 0.74 | |||
Conntrol of bleeding | 0.370 | |||||
EST (n = 10) | 7 (70.0) | 3 (30.0) | ||||
EVL (n = 89) | 76 (85.4) | 13 (14.6) | ||||
Glue (n = 4) | 3 (75.0) | 1 (25.0) | ||||
Combinations (n = 66) | 59 (89.4) | 7 (10.6) | ||||
Compliance to endotreatment | 0.022* | 0.30 | 0.298 (0.03–2.86) | |||
Good | 141 (87.6) | 20 (12.4) | ||||
Poor | 11 (64.7) | 6 (35.3) | ||||
Variceal obliteration | 0.827 | |||||
Yes | 90 (86.5) | 14 (13.5) | ||||
No | 61 (84.7) | 11 (15.3) | ||||
Jaundice | 0.121 | |||||
Yes | 46 (79.3) | 12 (20.7) | ||||
No | 120 (88.2) | 16 (11.8) | ||||
Cholangitis | 0.014* | 0.27 | 0.204 (0.04–2.03) | |||
Yes | 17 (68.0) | 8 (32.0) | ||||
No | 149 (88.2) | 20 (11.8) | ||||
Gall stone | 0.043* | 0.42 | 0.260 (0.09–1.91) | |||
Yes | 30 (75.0) | 10 (25.0) | ||||
No | 136 (88.3) | 18 (11.7) | ||||
Bile duct stone | 0.003* | 0.93 | 0.947 (0.10–8.23) | |||
Yes | 9 (56.3) | 7 (43.8) | ||||
No | 157 (88.2) | 21 (11.8) | ||||
Secondary biliary cirrhosis | 0.375 | |||||
Yes | 2 (66.7) | 1 (33.3) | ||||
No | 164 (85.9) | 27 (14.1) | ||||
Ascites | 0.476 | |||||
Yes | 15 (93.8) | 1 (6.2) | ||||
No | 151 (84.8) | 27 (15.2) | ||||
Splenic artery aneurysm | 0.010* | 0.01 | 0.007* (0.00–0.31) | |||
Yes | 1 (25.0) | 3 (75.0) | ||||
No | 165 (86.8) | 25 (13.2) | ||||
Liver atrophy | ||||||
Yes | 3 (75.0) | 1 (25.0) | 0.495 | |||
No | 163 (85.8) | 27 (14.2) | ||||
Appearance of gastric varices | ||||||
Yes | 51 (83.6) | 10 (16.4) | 0.661 | |||
No | 115 (86.5) | 18 (13.5) | ||||
Bleeder | ||||||
Yes | 88 (84.6) | 16 (15.4) | 0.838 | |||
No | 78 (86.7) | 12 (13.3) | ||||
Hypersplenism | ||||||
None | 113 (84.3) | 21 (15.7) | 0.374 | |||
Asymptomatic | 32 (84.2) | 6 (15.8) | ||||
Symptomatic | 21 (95.5) | 1 (4.5) | ||||
Portal biliopathy | 0.004* | 0.86 | 0.885 (0.12–6.16) | |||
Yes | 37 (72.5) | 14 (27.5) | ||||
No | 129 (90.2) | 14 (9.8) | ||||
Mode of surgery | > 0.999 | |||||
Elective | 150 (85.2) | 26 (14.8) | ||||
Emergency | 16 (88.9) | 2 (11.1) | ||||
Esophageal varices at the time of surgery | 0.456 | |||||
Grade 0 | 99 (85.3) | 17 (14.7) | ||||
Grade 1 | 19 (95.0) | 1 (5.0) | ||||
Grade 2 | 32 (80.0) | 8 (20.0) | ||||
Grade 3 | 16 (88.9) | 2 (11.1) | ||||
Gastroesophageal varices | 0.481 | |||||
Present | 124 (95.4) | 6 (4.6) | ||||
Absent | 42 (89.4) | 5 (10.6) | ||||
Isolated gastric varices | 0.023* | 0.07 | 0.004* (0.01–0.43) | |||
Present | 151 (87.8) | 21 (12.2) | ||||
Absent | 15 (68.2) | 7 (31.8) | ||||
Portal hypertensive gastropathy | 0.403 | |||||
No | 133 (86.4) | 21 (13.6) | ||||
Mild | 29 (85.3) | 5 (14.7) | ||||
Severe | 4 (66.7) | 2 (33.3) | ||||
Ectopic varices | 0.330 | |||||
Present | 161 (86.1) | 26 (13.9) | ||||
Absent | 5 (71.4) | 2 (28.6) | ||||
Colopathy | 0.467 | |||||
Present | 163 (85.8) | 27 (14.2) | ||||
Absent | 3 (75.0) | 1 (25.0) | ||||
ERC & stenting | 0.002* | 0.06 | 0.015* (0.01–0.59) | |||
Yes | 155 (88.6) | 20 (11.4) | ||||
No | 11 (57.9) | 8 (42.1) | ||||
Hemoglobin (gm%) | 8.86 ± 2.54 | 9.07 ± 1.93 | 0.678 | |||
TLC (×103/cumm) | 3.74 ± 3.17 | 4.56 ± 3.71 | 0.221 | |||
Bilirubin (mg/dL) | 1.44 ± 1.19 | 2.39 ± 2.85 | 0.003* | 0.99 | 0.976 (0.66–1.49) | |
INR | 1.35 ± 0.98 | 1.35 ± 0.61 | 0.990 | |||
AST (U/L) | 49.50 ± 50.10 | 64.04 ± 55.09 | 0.163 | |||
ALT (U/L) | 41.64 ± 52.37 | 47.39 ± 33.75 | 0.541 | |||
Alkaline phosphatase (IU/L) | 207.84 ± 222.04 | 390.21 ± 883.81 | 0.023* | 1.00 | 0.279 (1.00–1.00) | |
Type of surgery | 0.274 | |||||
Shunt procedure | 140 (84.3) | 26 (15.7) | ||||
Non-shunt procedure | 21 (75.0) | 7 (25.0) | ||||
Splenic vein diameter (mm) | 9.11 ± 4.42 | 10.52 ± 4.32 | 0.135 | |||
Shunt size (mm) | 11.83 ± 4.3 | 12.48 ± 4.3 | 0.520 | |||
Duration of surgery (min) | 270.61 ± 75.6 | 295.21 ± 93.53 | 0.126 | |||
Operative blood loss (mL) | 332.35 ± 251.08 | 485.71 ± 427.28 | 0.009* | 1.00 | 0.435 (1.00–1.00) | |
PRBC (unit) | 0.72 ± 1.29 | 0.75 ± 1.38 | 0.901 | |||
Postoperative stay (day) | 7.16 ± 3.42 | 7.75 ± 5.75 | 0.449 | |||
Shunt patency | < 0.001* | 0.03 | < 0.001* (0.00–0.19) | |||
Present | 135 (90.0) | 15 (10.0) | ||||
Absent | 3 (33.3) | 6 (66.7) |
Binary logistic regression in Wald methodology was used to know the predictive factors responsible for unfavourable outcome.
OR, odds ratio; CI, confidence interval; EST, endoscopic sclerotherapy; EVL, endoscopic variceal ligation; ERC, endoscopic retrograde cholangiography; TLC, total leukocyte count; INR, International normalized ratio; AST, aspartate aminotransferase; ALT, alanine transaminase; PRBC, packed red blood cell.
Table 6
Author | Year | Type of PSS | No. of Patients | Operative mortality (%) | Shunt patency (%) | Re-bleeding (%) | Follow-up period | Survival |
---|---|---|---|---|---|---|---|---|
Bismuth et al. [36] | 1980 | Central splenorenal, mesocaval, portocaval | 52 | 0 | 94 | 2 | 50 mon | 100% |
Warren et al. [61] | 1988 | Distal splenorenal shunt | 25 | Nil | 96 | 12 | 5 yr | 96% |
Mitra et al. [32] | 1993 | SSLR | 81 | Nil | 84 | 11 | 54 mon | 100% |
Prasad et al. [30] | 1994 | PSRS | 160 | 1.9 | NA | 11 | 12–156 mon | 95% at 15 yr |
Orloff et al. [31] | 1994 | PSRS, SSLR, mesocaval | 162 | Nil | 98 | 2 | 5–35 yr | 96% at 10 yr |
Rao et al. [33] | 2004 | SSLR, PSRS | 20 | NA | 95 | Nil | 3–5 yr | 95% |
Superina et al. [60] | 2006 | Rex shunt | 34 | NA | 95 | NA | 1–7 yr | 100% |
Sharif et al. [62] | 2010 | Rex shunt | 24 | Nil | 96 | 2 | 5.3–8.8 yr | NA |
Das et al. (current study) | 2023 | PSRS, mesocaval | 166 | 0.6 | 93.4 | 0.6 | 1–13 yr | 96% |