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[Triplex operations for children with extrahepatic portal hypertension]
Tingze Hu1, Jiexiong Feng, Wenying Liu
1Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, PR China.
Summary
The triplex operation effectively controlled upper gastrointestinal bleeding in children with extrahepatic portal hypertension. This surgical approach significantly reduced portal pressure and varices, offering a safe and beneficial treatment option.
Area of Science:
- Pediatric Surgery
- Hepatology
- Vascular Surgery
Context:
- Extrahepatic portal hypertension (EHPHT) in children presents a significant risk of life-threatening upper gastrointestinal bleeding due to esophageal and gastric varices.
- Traditional management strategies for EHPHT have limitations, necessitating evaluation of alternative surgical interventions.
Purpose:
- To assess the efficacy and safety of a "triplex operation"—comprising splenopneumopexy, portal azygous devascularization, and splenic artery ligation—in pediatric patients diagnosed with EHPHT.
- To evaluate the impact of the triplex operation on portal hemodynamics, variceal burden, and hematological parameters.
Summary:
- Seven children with EHPHT underwent the triplex operation, with follow-up ranging from 2 to 8 years.
- Post-operative outcomes demonstrated complete control of gastrointestinal hemorrhage, significant reduction in free portal pressure (from 42.62±6.72 to 34.48±5.71 cm H2O), and mitigation of varices.
- Hematological indices, including white blood cell and platelet counts, along with blood viscosity and hematocrit, normalized after the procedure.
Impact:
- The triplex operation is a safe and effective surgical procedure for managing hemorrhage associated with varices in pediatric patients suffering from extrahepatic portal hypertension.
- This intervention offers a viable solution for controlling bleeding and improving hematological status in this challenging pediatric condition.