Effect of Proximal Splenorenal Shunt on Intraoperative Portal Venous Pressure and Its Correlation with Clinical Outcomes

Proximal splenorenal shunt (PSRS), commonly performed for non-cirrhotic portal hypertension (NCPH), diminishes elevated portal venous pressure (PP) and prevents its sequelae. The change in PP after PSRS and its correlation with clinical outcome is largely unknown. Twenty-four patients who underwent PSRS for NCPH were evaluated prospectively. PP was measured after completion of splenectomy and after PSRS. Follow-up for 3 months was done to assess shunt patency and other relevant clinical variables. Change in PP and shunt patency were correlated with clinical outcome. Seventeen patients had extrahepatic portal vein obstruction (EHPVO) and seven had non-cirrhotic portal fibrosis (NCPF). There was a significant decrease in PP (median10 mmHg) after PSRS ( p < 0.001), while decrease following splenectomy alone was not significant ( p = 0.06). At 3 months, shunt patency rate was 87.5%. There was improvement in variceal grade at follow-up ( p < 0.001). Change in PP did not correlate with splenic vein diameter, shunt diameter, blood flow across the shunt, shunt patency, postoperative complications, change in variceal grade, and need for endotherapy after surgery ( p > 0.05). Shunt patency showed significant correlation with splenic vein diameter ( p = 0.018), shunt diameter ( p = 0.024), blood flow across shunt ( p = 0.023), change in variceal grade ( p = 0.032), and need for endotherapy ( p = 0.002). PP decreases after PSRS in patients with NCPH. However, this does not correlate with clinical outcome. A patent shunt at 3 months correlated with most of these variables.