한국간담췌외과학회지 (Annals of Hepato-Biliary-Pancreatic Surgery)

  • 제26권2호
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  • Pages.178-183
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  • 2022
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  • 2508-5778(pISSN)
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  • 2508-5859(eISSN)
한국간담췌외과학회 (The Korean Association of Hepato-Biliary-Pancreatic Surgery)
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Use of caudal pancreatectomy as a novel adjunct procedure to proximal splenorenal shunt in patients with noncirrhotic portal hypertension: A retrospective cohort study

  • Shahana Gupta (Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research) ;
  • Biju Pottakkat (Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research) ;
  • Raja Kalayarasan (Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research) ;
  • Gnanasekaran Senthil (Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research) ;
  • Pagadala Naga Balaji Nitesh (Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research)
  • 투고 : 2021.07.12
  • 심사 : 2021.11.08
  • 발행 : 2022.05.31
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초록

Backgrounds/Aims: Proximal splenorenal shunt (PSRS) is considered a one-time treatment for noncirrhotic portal hypertension (NCPH) to prevent recurrent upper gastrointestinal (UGI) hemorrhage and long-term complications. Long-term shunt patency is necessary to achieve these. The lie of the shunt is a contributing factor to early shunt thrombosis. We investigated the role of resection of the distal tail of pancreas (caudal pancreatectomy [CP]) in improving the lie of shunt and decreasing shunt thrombosis. Methods: This was a retrospective cohort study of patients with NCPH who underwent PSRS between 2014-2020 in JIPMER, Puducherry, India. CP was performed in patients with a long tail of pancreas, with the tip of pancreatic tail extending up to splenic hilum on preoperative CT. Perioperative parameters and shunt patency rate of patients who underwent PSRS with CP (Group A) were compared with patients undergoing conventional PSRS (Group B). Statistical analysis was performed using the Mann-Whitney U test and χ2 test. Results: Eighty four patients with NCPH underwent PSRS (extrahepatic portal vein obstruction = 39; noncirrhotic portal fibrosis = 45). Blood loss was lower (p = 0.002) and post-shunt fall in portal pressure higher (p = 0.002) in Group A. Shunt thrombosis rate was lower (p = 0.04) while rate of complete variceal regression (p = 0.03) and biochemical pancreatic leak (p = 0.01) were higher in Group A.There was no clinically relevant pancreatic fistula in either group. Conclusions: CP is a safe and useful technique for reducing shunt thrombosis after PSRS in patients with NCPH by improving the lie of shunt.

키워드

과제정보

The authors thank Dr. Bharath Konan of the Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry for his support.

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