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Updated: Jan 20, 2026
Invasive Hemodynamic Characterization of the Portal-hypertensive Syndrome in Cirrhotic Rats
Published on: August 1, 2018
Revisiting the Role of Surgery in Non-cirrhotic Portal Hypertension: An Ambispective Observational Study in a
Adarsh Girish1, Prabhakaran R1, Sugumar Chidambaranathan1
1Surgical Gastroenterology, Madras Medical College, Chennai, IND.
Insights
Surgical interventions for non-cirrhotic portal hypertension (NCPH) effectively prevent variceal bleeding and improve hematological parameters. Surgery offers favorable outcomes, supporting its consideration as a primary treatment for selected NCPH patients.
Area of Science:
- Gastroenterology
- Hepatology
- Surgical Gastroenterology
Background:
- Non-cirrhotic portal hypertension (NCPH), encompassing conditions like extrahepatic portal vein obstruction (EHPVO) and non-cirrhotic portal fibrosis (NCPF), is often managed with endoscopic and medical therapies for variceal bleeding.
- Surgical interventions are typically reserved for refractory cases, but their efficacy in controlling bleeding and managing other NCPH complications warrants re-evaluation.
Purpose of the Study:
- To evaluate the efficacy of surgical management, specifically proximal splenorenal shunt (PSRS) or splenectomy with esophagogastric devascularization, in patients with NCPH.
- To assess the impact of surgery on rebleeding rates, variceal resolution, and hematological parameters.
Main Methods:
- An ambispective single-center study included NCPH patients who underwent either PSRS or splenectomy with esophagogastric devascularization.
- Preoperative data were collected, and postoperative follow-up assessed rebleeding, endoscopic findings, hematological parameters, and need for further endoscopic therapy.
Main Results:
- Optimal outcomes (no rebleeding, grade 0-I varices, no further endoscopic therapy) were achieved in 74.1% of patients.
- The proximal splenorenal shunt group had an 84% optimal outcome rate, while splenectomy with devascularization yielded 66.6% optimal outcomes.
- Surgical intervention significantly improved hemoglobin, white blood cell count, and platelet count, with marked variceal grade reduction.
Conclusions:
- Surgical management of NCPH is highly effective in preventing esophagogastric variceal rebleeding.
- Surgery leads to favorable outcomes, including variceal resolution and reduced need for postoperative endoscopic interventions.
- These findings suggest surgery should be considered a primary management option for selected NCPH patients, not just a last resort.
Background:
Extrahepatic portal vein obstruction (EHPVO) and non-cirrhotic portal fibrosis (NCPF) come under the broad category of non-cirrhotic portal hypertension (NCPH). Current management of this condition primarily focuses on controlling and preventing variceal bleeding through endoscopic and medical therapy, with surgery typically reserved for cases where endotherapy fails. However, the role of surgical interventions, either shunt surgery or splenectomy with esophagogastric devascularization, warrants re-evaluation due to their possible efficacy in controlling variceal bleeding. In addition, surgery addresses other complications associated with NCPH, including symptomatic splenomegaly, hypersplenism, and portal biliopathy.
Methods:
In this ambispective single-centre study, patients with NCPH who underwent either proximal splenorenal shunt (PSRS) or splenectomy with esophagogastric devascularization were included. Preoperative data were extracted from electronic medical records, while postoperative follow-up focused on assessing rebleeding episodes, esophagogastroduodenoscopy findings, hematological parameters, and the requirement for additional endoscopic interventions. Optimal outcome was defined as the absence of rebleeding/new-onset bleeding, resolution of varices to grade 0-I, and no postoperative requirement for endoscopic therapy.
Results:
Rebleeding or new-onset bleeding occurred postoperatively in only one patient (2.5%) from the entire study population. Overall, optimal outcomes were achieved in 43 patients (74.1%). On subgroup analysis, 21 patients (84%) of the PSRS group and 22 patients (66.6%) who underwent splenectomy with devascularization achieved optimal outcomes. Surgical intervention was associated with significant improvement in hemoglobin, total leukocyte count, and platelet count, along with a marked reduction in variceal grade on follow-up endoscopy.
Conclusion:
Surgical management in NCPH is highly effective in preventing rebleeding from esophagogastric varices and yields favorable outcomes in terms of variceal resolution and reduced postoperative need for endoscopic interventions. These findings support the consideration of surgery as a primary management option in selected patients with NCPH and not just in those who have failed medical and endoscopic options.
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