Reappraisal of shunt surgery for extrahepatic portal vein obstruction in adults: Report of a single-center case series

Aim: Extrahepatic portal venous obstruction (EHPVO) is a relatively rare disease in adults. The clinical significance of shunt surgery for EHPVO in adult cases remains unclear. Methods: We retrospectively analyzed the patient characteristics and the results of shunt surgery in 13 adult cases of EHPVO treated between March 1995 and March 2013 at a tertiary care hospital in Switzerland. The indication for shunt surgery was recurrent bleeding after endoscopic treatment. To update the outcomes of shunt surgery in adult cases of EHPVO, we performed a systematic review of published work to examine this issue. Results: The mean age of the 13 patients in the present case series was 41.8 years (range, 20-68), and the mean follow-up duration after surgery was 4.4 years (range, 1-16). The types of shunt surgery performed were mesocaval shunt (n = 8), portacaval shunt (n = 2), splenorenal shunt (n = 1) and mesorenal shunt (n = 2). Two patients (15%) developed postoperative rebleeding, which was successfully treated by endoscopic treatment. None of the patients developed postoperative hepatic encephalopathy. No operative-related deaths occurred in this series. Six studies, including our own, were identified in the published work. The overall mortality rate was 0-3.7%, and no cases of encephalopathy were observed. The rebleeding rate ranged 2.5-23%. Conclusion: Shunt surgery for EHPVO in adults after the failure of endoscopic treatment is feasible, with acceptable outcomes at specialized centers. This surgical procedure should always be taken into consideration when managing adult cases of EHPVO.