Proximal Splenorenal Shunt in Non-cirrhotic Portal Hypertension: Our Experience

Background Non-cirrhotic portal hypertension (NCPH) is characterized by an elevated portal pressure without liver disease and without obvious venous thrombosis. It is characterized by splenomegaly and gastroesophageal varices with intact liver histology. Extrahepatic portal vein obstruction (EHPVO) and non-cirrhotic portal fibrosis (NCPF) come under the umbrella of NCPH. EHPVO is further characterized by portal cavernoma, cholangiopathy, and growth retardation. Surgical shunts remain a definitive option for patients requiring frequent endoscopies. This study was done to evaluate the surgical outcomes of proximal splenorenal shunt (PSRS) in patients of NCPH. Methods Ten NCPH patients underwent PSRS at Moti Lal Nehru Medical College, Prayagraj, between April 2024 and April 2026. Preoperative workup included routine blood tests, Doppler of the splenoportal axis, and contrast-enhanced computed tomography (CECT) of the abdomen for anatomical delineation. Preoperative triple vaccination was done in all the patients. A reverse Makucchi incision was used. All the patients were put on anticoagulant and underwent a follow-up Doppler examination. Perioperative events, complications, and short-term outcomes were recorded. Results All the patients had grade II-V splenomegaly, cytopenias, and preserved liver function. The mean duration of surgery was 295 minutes, and the blood loss was 490 ml. Six patients made an uneventful recovery. Two patients developed post-operative bleeding due to anticoagulant overdose and one of them required re-exploration. One patient developed hemothorax after central venous line insertion, which was managed with thoracocentesis. Conclusion PSRS offers an effective, one-time treatment for NCPH with manageable complications and favorable outcomes.