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[Porto-systemic shunts in children: Schneider Children's Medical Center experience]
Eytan Mor1, Nati Bar-Nathan, Riki Shapira
1Department of Transplantation, Schneider Children's Medical Center, Petah Tikva.
Insights
Porto-systemic shunts effectively manage extrahepatic portal hypertension in children, resolving bleeding and reducing spleen size. This surgical solution offers a definitive treatment for pediatric portal hypertension without liver disease.
Area of Science:
- Pediatric Surgery
- Hepatology
- Vascular Surgery
Context:
- Extrahepatic portal hypertension in children presents unique challenges.
- Variceal bleeding and hypersplenism due to enlarged spleen are significant risks.
- Porto-systemic shunts offer a definitive surgical solution.
Purpose:
- To evaluate the efficacy of porto-systemic shunts in pediatric patients with extrahepatic portal hypertension.
- To assess the outcomes of mesocaval and splenorenal shunts.
- To analyze the impact on portal pressure, bleeding, and splenomegaly.
Summary:
- Eight children underwent porto-systemic shunt procedures (mesocaval or splenorenal).
- Seven shunts remained patent, leading to decreased portal pressure and normalized platelet counts.
- No post-operative bleeding occurred, and splenomegaly reduced in affected children.
Impact:
- Porto-systemic shunts are indicated for pediatric non-hepatic portal hypertension with uncontrolled bleeding or massive splenomegaly.
- Successful shunt patency leads to improved clinical outcomes.
- This surgical approach provides a long-term solution for a challenging pediatric condition.
Unlabelled:
Portal hypertension in the absence of liver disease in children remains a therapeutic challenge. Despite successful control of variceal bleeding in most children, the risk of massive GI bleeding and mechanical disturbance of a huge spleen associated with hypersplenism exists throughout life. Surgical shunt between the portal and systemic venous systems is considered a definitive solution for that problem.
Aims:
We present our experience with the porto-systemic shunt for extrahepatic portal hypertension.
Patients And Methods:
Nine children (mean age 11.4 years) with portal hypertension were referred for a shunt procedure during a 5-year period (1996-2001). We reviewed patients charts for clinical parameters before and after surgery as well as surgical data (type of shunt, portal pressure gradient). A mesocaval shunt was constructed in 5 children, a splenorenal shunt in 3 other children and one child with splenic vein thrombosis underwent splenectomy alone for presumed diagnosis of left sided portal hypertension.
Results:
During a mean follow-up period of 21.2 months (range 6-63 months), the surgical shunt remained patent in 7 of the 8 children. An immediate drop in portal pressure and increased platelets count over time was noted in those 7 children. In two children high portal pressure persisted after surgery, including a child who underwent mesocaval shunt following a previous failed splenorenal shunt and another child who underwent splenectomy alone. None of the children bled following the shunt procedure and decreased splenic size was observed in the 3 children with massive splenomegaly.
Conclusions:
We suggest that the porto-systemic shunt is indicated for children with non-hepatic portal hypertension suffering with uncontrolled bleeding and those with massive splenomegaly associated with hypersplenism.
