{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T13:31:19Z","timestamp":1775050279291,"version":"3.50.1"},"reference-count":39,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2013,5,22]],"date-time":"2013-05-22T00:00:00Z","timestamp":1369180800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2013,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>In patients with extrahepatic portal venous obstruction (<jats:styled-content style=\"fixed-case\">EHO<\/jats:styled-content>), death is usually due to variceal bleeding. This is more so in developing countries where there is a lack of tertiary health\u2010care facilities and blood banks. Prophylactic operations in cirrhotics have been found to be deleterious. In contrast, patients with <jats:styled-content style=\"fixed-case\">EHO<\/jats:styled-content> have well\u2010preserved liver function, and we therefore investigated the role of prophylactic surgery to prevent variceal bleeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between 1976 and 2010, we operated on selected patients with <jats:styled-content style=\"fixed-case\">EHO<\/jats:styled-content>, who had no history of variceal bleeding but had \u201chigh\u2010risk\u201d esophagogastric varices or severe portal hypertensive gastropathy and\/or hypersplenism, and came from remote areas with poor access to tertiary health care. Following surgery, these patients were prospectively followed up with regard to mortality, variceal bleeding, encephalopathy, and liver function.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 114 patients (67 males; mean age 19 years) underwent prophylactic operations (proximal splenorenal shunts 98 [86%]; esophagogastric devascularization 16). Postoperative mortality was 0.9%. Among 89(79%) patients who were followed up (mean 60 months), hypersplenism was cured, and six (6.7%) developed variceal bleeding. The latter were managed successfully by endoscopic sclerotherapy. No patient developed overwhelming post\u2010splenectomy sepsis or encephalopathy, and 90% were free of symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In patients with <jats:styled-content style=\"fixed-case\">EHO<\/jats:styled-content>, prophylactic surgery is fairly safe and prevents variceal bleeding in \u223c 94% of patients with no occurrence of portosystemic encephalopathy. Patients with <jats:styled-content style=\"fixed-case\">EHO<\/jats:styled-content> who have not bled but have high\u2010risk varices and\/or hypersplenism, and poor access to medical facilities should be offered prophylactic operations.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.12123","type":"journal-article","created":{"date-parts":[[2013,1,10]],"date-time":"2013-01-10T06:07:03Z","timestamp":1357798023000},"page":"1010-1014","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Surgery as primary prophylaxis from variceal bleeding in patients with extrahepatic portal venous obstruction"],"prefix":"10.1111","volume":"28","author":[{"given":"Sujoy","family":"Pal","sequence":"first","affiliation":[{"name":"Department of GI Surgery and Liver Transplantation All India Institute of Medical Sciences  India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivek","family":"Mangla","sequence":"additional","affiliation":[{"name":"Department of GI Surgery and Liver Transplantation All India Institute of Medical Sciences  India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patta","family":"Radhakrishna","sequence":"additional","affiliation":[{"name":"Department of GI Surgery and Liver Transplantation All India Institute of Medical Sciences  India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peush","family":"Sahni","sequence":"additional","affiliation":[{"name":"Department of GI Surgery and Liver Transplantation All India Institute of Medical Sciences  India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Girish Kumar","family":"Pande","sequence":"additional","affiliation":[{"name":"Department of Surgery Launceston General hospital  Launceston Tasmania Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Subrat Kumar","family":"Acharya","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Human Nutrition All India Institute of Medical Sciences  India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tushar Kanti","family":"Chattopadhyay","sequence":"additional","affiliation":[{"name":"Department of GI Surgery and Liver Transplantation All India Institute of Medical Sciences  India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samiran","family":"Nundy","sequence":"additional","affiliation":[{"name":"Department of Surgical Gastroenterology Sir Ganga Ram Hospital  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,5,22]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa044456"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-008-9096-8"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2010.06.004"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2001.23054"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199106203242505"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/ncpgasthep0192"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0168-8278(92)90059-X"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2006.01269.x"},{"key":"e_1_2_5_10_1","unstructured":"BasuAK.Surgical management of juvenile portal hypertension. 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