Surgical Management of Portal Hypertension: Experience at a Medical College Hospital in South India

ABSTRACT

Introduction: Portal hypertension in the presence of cirrhosisof liver carries poor prognosis. The medical managementalong with endoscopic therapy helps to reduce bleeding.Surgery is reserved for patients who fail medical therapy.Patients with portal hypertension with good functioning liverbenefit from surgery. Study aimed to evaluate the resultsof surgical treatment for portal hypertension at our centerKarnataka Institute of Medical Sciences Hubli. Karnataka.Material and methods. This was a prospective observationalstudy. There were 34 patients undergoing surgical treatmentfor various presentations of portal hypertension during theperiod of 2015 to 2019.They were analyzed for demographics,etiology, presentation, various surgeries and outcome. Thedata was entered intoMicrosoft excel sheet and analyzed.Results: Of the 34 patients males were most common.Variceal bleeding was most common presentation followedby painful splenomegaly and anemia. ‘Extrahepatic portalvein obstruction’ was the leading cause of non-cirrhoticportal hypertension followed by ‘non cirrhotic portal fibrosis’and ‘left sided or sinistral portal hypertension’. Proximallinorenal shunt was the most common procedure followedby splenectomy with esophagogastric devascularization. Themorbidity and mortality were very low and yielded durablesatisfactory outcome.Conclusion: The surgery for non-cirrhotic portalhypertension has durable and satisfactory results and canbe done with minimal morbidity and mortality at trainedhands. For few selected cirrhotic patients surgery in the formof devascularization or shunt offers immediate relief frombleeding and gives time for future transplant if any.