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Portosystemic shunting in children during the era of endoscopic therapy: improved postoperative growth parameters
1Division of Transplantation, University of Miami, School of Medicine, Florida 33136, USA.
Insights
Surgical portosystemic shunting in children with portal hypertension is safe and effective, leading to improved growth. This procedure offers significant benefits for selected pediatric patients.
Area of Science:
- Pediatric Surgery
- Hepatology
- Vascular Surgery
Background:
- Surgical portosystemic shunting is less common but remains relevant for pediatric portal hypertension.
- Evaluation of outcomes in the era of advanced endoscopic therapies is crucial.
Purpose of the Study:
- To describe recent outcomes of surgical portosystemic shunting in children.
- To assess the procedure's role in managing pediatric portal hypertension.
Main Methods:
- Retrospective chart review of pediatric patients undergoing shunt procedures (1994-1997).
- Analysis of patient demographics, shunt types, and clinical outcomes.
Main Results:
- Twelve children (age 1-16) with various causes of portal hypertension underwent shunting.
- All patients survived with patent shunts; significant improvements in weight and height z-scores observed.
- Complications included shunt stenosis and small bowel obstruction in a minority of patients.
Conclusions:
- Surgical portosystemic shunting is a safe and effective treatment for pediatric portal hypertension.
- The procedure significantly improves growth parameters in children.
- Consideration of surgical portosystemic shunting for selected pediatric patients is recommended.
Background:
Surgical portosystemic shunting has been performed less frequently in recent years. In this retrospective study, recent outcomes of portosystemic shunting in children are described, to evaluate its role in the era of endoscopic therapy.
Methods:
Retrospective chart review of children who underwent surgical portosystemic shunt procedures between October 1994 and October 1997.
Results:
Twelve children (age range, 1-16 years) underwent shunting procedures. The causes of portal hypertension were extrahepatic portal vein thrombosis (n = 6), congenital hepatic fibrosis (n = 2), hepatic cirrhosis (n = 2), and other (n = 2). None of the patients were immediate candidates for liver transplantation. Types of shunt included: distal splenorenal (n = 10), portocaval (n = 1), and other (n = 1). Median follow-up was 35 months (range, 24-48 months). All patients are currently alive and well with patent shunts. The mean hospital stay was 8 days. Three patients required readmission for further interventions because of shunt stenosis in two and small bowel obstruction in the other. Mild portosystemic encephalopathy was seen in one child with pre-existing neurobehavioral disturbance. Excluding a patient who underwent placement of a portosystemic shunt for a complication of liver transplantation, mean weight-for-age z score in nine prepubertal patients improved from -1.16 SD to +0.15 SD (P = 0.023), and mean height-for-age z score from -1.23 SD to 0.00 SD (P = 0.048) by 2 years after surgery.
Conclusions:
Surgical portosystemic shunting is a safe and effective method for the management of portal hypertension in childhood. Patients show significant improvements in growth parameters after the procedure. Surgical portosystemic shunting should be actively considered in selected children with portal hypertension.