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Updated: Aug 15, 2026
Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
Extrahepatic portal hypertension in children: observations on three surgical procedures
K L N Rao1, Anju Goyal, Prema Menon
1Department of Pediatric Surgery, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, 160 012 Chandigarh, India. klnrao@hotmail.com
Insights
This study compared three surgical treatments for extrahepatic portal hypertension in children. Side-to-side lienorenal shunt (SSLR) showed reduced blood loss and operating time, with all procedures preventing re-bleeding.
Area of Science:
- Pediatric Surgery
- Hepatology
- Vascular Surgery
Background:
- Extrahepatic portal hypertension (EHPHT) in children presents significant management challenges.
- Surgical interventions aim to decompress the portal system and manage complications like variceal bleeding and hypersplenism.
Purpose of the Study:
- To compare the efficacy and outcomes of three surgical modalities for EHPHT in pediatric patients.
- To evaluate central splenorenal shunt after splenectomy (CSS), side-to-side lienorenal shunt (SSLR) without splenectomy, and splenectomy with gastroesophageal devascularization (SGD).
Main Methods:
- A prospective comparative study involving 27 pediatric patients undergoing EHPHT surgery over 18 months.
- Procedures included CSS (10), SSLR (10), and SGD (7).
- Outcomes assessed included portal pressure reduction, hematological parameters, shunt patency, splenic size, and esophageal varices.
Main Results:
- All three procedures effectively reduced portal pressure.
- SSLR demonstrated significantly less blood loss and shorter operating times compared to CSS.
- Shunt patency was high (100% for SSLR, 90% for CSS) at 3 months; hypersplenism resolved in CSS and SGD groups.
- No patient experienced re-bleeding, hepatic encephalopathy, or overwhelming postsplenectomy sepsis during 3-5 years of follow-up.
Conclusions:
- CSS is indicated for large spleens, severe hypersplenism, and shuntable splenic veins.
- SSLR is suitable for mild splenomegaly/hypersplenism with a shuntable splenic vein.
- SGD is the preferred option when a shuntable splenic vein is absent.
Abstract:
This paper presents a comparative prospective study of three modalities of surgical treatment for extrahepatic portal hypertension in children: central splenorenal shunt after splenectomy (CSS), side-to-side lienorenal shunt (SSLR) without splenectomy, and splenectomy and gastroesophageal devascularization (SGD). In an 18-month period, 27 procedures were performed: 10 CSS, 10 SSLR, and seven SGD. The outcomes were evaluated by fall in portal pressures, hematological parameters, shunt patency, splenic regression, and disappearance of esophageal varices. All three procedures were comparable in the fall of portal pressure after surgery. The average blood loss and operating time were statistically significant in favor of SSLR compared with CSS. At 3-month follow-up, shunt patency was confirmed by duplex Doppler study in all the patients in the SSLR group and in nine out of 10 patients in the CSS group. In the CSS and SGD groups, hypersplenism resolved in all the patients. In the SSLR group, blood counts improved in only five out of eight affected children. No patient re-bled during a follow-up of 3-5 years. There were no cases of hepatic encephalopathy or overwhelming postsplenectomy sepsis. In conclusion, CSS is useful when there is a large spleen, severe hypersplenism, and a shuntable splenic vein. SSLR is suitable when there is only mild splenomegaly, mild hypersplenism, and a shuntable splenic vein. Splenectomy and devascularization is the choice when there is no shuntable splenic vein.
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