Related Experiment Videos
Triplex operation for children with extrahepatic portal hypertension
Hu Tingze1, Feng Jiexiong, Liu Wenying
1Department of Pediatric Surgery and Ultrasonography, Huaxi Hospital, Sichuan University, Chengdu, China.
Insights
The triplex operation effectively controls upper gastrointestinal bleeding in children with extrahepatic portal hypertension. This surgical approach significantly reduces esophageal and gastric varices and portal pressure, offering a viable treatment option.
Area of Science:
- Pediatric Surgery
- Hepatology
- Gastroenterology
Background:
- Extrahepatic portal hypertension presents a significant challenge in pediatric patients, often leading to severe gastrointestinal bleeding from esophageal and gastric varices.
- Effective management strategies for these varices are crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of the triplex operation (splenopneumopexy, portal azygous devascularization, and splenic artery ligation) in managing esophageal and gastric varices in children with extrahepatic portal hypertension.
- To assess the impact of the triplex operation on portal pressure, variceal size, and bleeding episodes.
Main Methods:
- A cohort of 7 children with extrahepatic portal hypertension underwent the triplex operation between March 1993 and November 1998.
- Diagnosis was confirmed using gastroscopy, barium meal, and Doppler ultrasonography. Postoperative assessments included monitoring bleeding episodes, variceal degree, spleen and portal vein diameters, portal pressure, and hemorheological indices.
- Follow-up ranged from 1 to 7 years (mean 4.6 years).
Main Results:
- The triplex operation demonstrated no operative mortality and completely controlled upper gastrointestinal bleeding.
- Significant reductions in free portal pressure (FPP) were observed, decreasing from 42.62 +/- 6.72 cm H2O to 34.48 +/- 5.71 cm H2O (P <.05).
- Variceal size decreased, portal blood flow was reduced, and white blood cell and platelet counts increased post-operation.
Conclusions:
- The triplex operation is a safe and effective surgical intervention for controlling hemorrhage from esophageal and gastric varices in pediatric patients with extrahepatic portal hypertension.
- The procedure leads to favorable hemodynamic changes and clinical improvements in affected children.
Background/Purpose:
How to deal with the vexatious problem of esophageal and gastric varices secondary to extrahepatic portal hypertension has been discussed extensively among pediatric surgeons around the world. The aim of this study is to evaluate the effect of triplex operation (splenopneumopexy, portal azygous devascularization, and ligation of splenic artery) for children with portal hypertension in the author's hospital.
Methods:
From March 1993 to November 1998, 7 children with extrahepatic portal hypertension were admitted to the author's hospital to undergo triplex operation. The diagnoses of these patients were confirmed by gastroscopy, barium meal, and Doppler ultrasonography. The number of white blood cells and platelets and the hepatic function were checked before and after operation. And the free portal pressures (FPP) were checked before and after the ligation of the splenic artery. All patients underwent follow-up for 1 to 7 years (mean, 4.6 years). The episodes of upper gastrointestinal bleeding were recorded. The degree of varices of distal esophagus and proximal stomach were assessed by barium meal and gastroscopy. The diameters of the spleenic and portal vein were obtained by B ultrasonography. The portopulmonary shunt and portal blood flow were evaluated by color Doppler flow image (CDFI). The indices of hemorheology such as hematocrit, viscosity of whole blood and plasma, and the indexes of deformability and aggregability of red blood cells were obtained through viscometer (R-20 Seerle, Beijing, China).
Results:
There was no operative mortality in this group. Postoperatively, hemorrhage from the esophagus and gastric varices was completely controlled. Although the diameter of spleen reduced progressively, no patient's spleen recovered to normal during the follow-up period. The degree of varices was mitigated, and the FPP was decreased significantly to 34.48 +/- 5.71 cm H(2)O from the preoperative 42.62 +/- 6.72 cm H(2)O (P <.05). The rate of portal flow also was decreased. The direction of portal vein was bidirection (one part was away from the liver and the other was toward the liver). The numbers of white blood cells and platelets were increased. The viscosities of whole blood and hematocrit also were increased after operation.
Conclusion:
The triplex operation is an effective procedure for the control of hemorrhage from varices in children with extrahepatic portal hypertension.