Prophylactic surgery in non-cirrhotic portal fibrosis:is it worthwhile?

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dc.contributor.authorPal, Sujoyen_US
dc.contributor.authorRadhakrishna, Pen_US
dc.contributor.authorSahni, Peushen_US
dc.contributor.authorPande, Girish Ken_US
dc.contributor.authorNundy, Samiranen_US
dc.contributor.authorChattopadhyay, Tushar Ken_US
dc.date.accessioned2005-11-21en_US
dc.date.accessioned2009-05-29T03:14:20Z
dc.date.available2005-11-21en_US
dc.date.available2009-05-29T03:14:20Z
dc.date.issued2005-11-21en_US
dc.description.abstractBACKGROUND: In cirrhotic patients with portal hypertension prophylactic portasystemic shunts have been found to be ineffective as deaths from post-shunt liver failure exceed those from bleeding. However, in patients with non-cirrhotic portal hypertension, variceal bleeding rather than liver failure is the common cause of death. In developing countries shortage of tertiary health-care facilities and blood banks further increases mortality due to variceal bleed. AIM: To study the results of prophylactic operations to prevent variceal bleeding in patients with portal hypertension due to non-cirrhotic portal fibrosis (NCPF). METHODS: Between 1976 and 2001, we performed 45 prophylactic operations in patients with NCPF, if the patients had high-risk esophagogastric varices or symptomatic splenomegaly and hypersplenism. Proximal lienorenal shunt was done in 41 patients and the remaining underwent splenectomy with (2 patients) or without (2 patients) devascularization. RESULTS: There was no operative mortality. Thirty-eight patients were followed up for a mean 49 (range, 12-236) months. Three patients bled - one was variceal and two due to duodenal ulcers; none died of bleeding. There were 2 late deaths (6 weeks and 10 years after surgery), one from an unknown cause and one due to chronic renal failure. The delayed morbidity was 47%. This included 7 patients who developed portasystemic encephalopathy, 4 glomerulonephritis, 2 pulmonary arteriovenous fistulae and 5 ascites requiring treatment with diuretics. Thus only 20 (53%) patients were symptom-free on follow up. CONCLUSIONS: Prophylactic surgery is safe and effective in preventing variceal bleeding in NCPF but at the cost of high delayed morbidity.en_US
dc.description.affiliationDepartment of GI Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India. sujoypal@hotmail.comen_US
dc.identifier.citationPal S, Radhakrishna P, Sahni P, Pande GK, Nundy S, Chattopadhyay TK. Prophylactic surgery in non-cirrhotic portal fibrosis:is it worthwhile? Indian Journal of Gastroenterology. 2005 Nov-Dec; 24(6): 239-42en_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/65101
dc.language.isoengen_US
dc.source.urihttps://www.indianjgastro.comen_US
dc.subject.meshAdolescenten_US
dc.subject.meshAdulten_US
dc.subject.meshChilden_US
dc.subject.meshEsophageal and Gastric Varices --prevention & controlen_US
dc.subject.meshFemaleen_US
dc.subject.meshFibrosisen_US
dc.subject.meshGastrointestinal Hemorrhage --prevention & controlen_US
dc.subject.meshHumansen_US
dc.subject.meshHypertension, Portal --surgeryen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshPortal Vein --pathologyen_US
dc.subject.meshPortasystemic Shunt, Surgicalen_US
dc.subject.meshPostoperative Complicationsen_US
dc.titleProphylactic surgery in non-cirrhotic portal fibrosis:is it worthwhile?en_US
dc.typeJournal Articleen_US
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