Pioneering Procedure at M.P. Shah Hospital

M.P. Shah Hospital marked a significant milestone in Kenyan medical history by performing the country’s first-ever selective oesophageal and gastric devascularization and splenectomy for extrahepatic portal hypertension.

This groundbreaking procedure was carried out to treat bleeding esophageal varices that were refractory to endoscopic banding, on a case-to-case basis.

The surgical team, led by Dr. Manvinder Mann and Dr. Karan Gandhi, with the assistance of intern Dr. Yasser and Dr. Rita Nyawira as assistant surgeon, executed the complex operation with precision. Anesthesia was administered by Dr. Roshni Ajmera, and the surgical team was supported by Nurse Maureen. The procedure involved an open left subcostal incision, followed by the individual ligation of veins draining the stomach and distal esophagus, including the critical coronary vein, and a splenectomy. This approach effectively removed the route of blood shunting due to portal hypertension and collapsed the varices, thereby significantly reducing the risk of further bleeding. Notably, no splenorenal shunt was required as the portal vein was found to be patent.

The patient, hailing from Somalia, had poor access to emergency healthcare and endoscopic banding. He presented with massive hematemesis from grade 4 oesophageal varices, which had been initially managed through band ligation. The underlying cause of his portal hypertension was identified as Bilharzia. After a comprehensive Multi-Disciplinary Team discussion, which included consultations with surgeons in South Africa, the decision was made to proceed with the devascularization and splenectomy, considering the patient’s unique circumstances and lack of access to TIPSS and emergency care.

This historic surgery at M.P. Shah Hospital not only showcases the institution’s commitment to advancing healthcare in Kenya but also provides a new treatment option for patients with similar conditions who are not candidates for TIPSS and lack access to emergency healthcare and endoscopic banding.