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Published on: October 14, 2022
Laparoscopic correction of congenital portosystemic shunt in children
Takuya Kimura1, Hideki Soh, Toshimichi Hasegawa
1Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. kimutaku@pedsurg.med.osaka-u.ac.jp
Insights
Minimally invasive laparoscopic surgery offers a new, effective treatment for children with congenital portosystemic shunts. This approach successfully ligated shunts, showing excellent short-term results and preventing serious complications.
Area of Science:
- Pediatric Surgery
- Vascular Surgery
- Gastroenterology
Background:
- Congenital portosystemic shunts are rare vascular anomalies.
- These shunts can lead to serious complications like jaundice, encephalopathy, and pulmonary hypertension.
- Current management includes surgical correction or coil embolization.
Purpose of the Study:
- To present a novel, minimally invasive surgical technique for managing congenital portosystemic shunts in children.
- To evaluate the feasibility and short-term outcomes of laparoscopic ligation for these shunts.
Main Methods:
- Laparoscopic identification and ligation of congenital portosystemic shunts.
- Case 1: Shunt between superior mesenteric vein and inferior vena cava.
- Case 2: Shunt between splenic vein and left renal vein.
- Post-ligation monitoring of portal venous pressure using catheters.
Main Results:
- Successful laparoscopic ligation of congenital portosystemic shunts in both cases.
- Patients tolerated the procedure well with no immediate complications.
- Excellent short-term outcomes observed post-operatively.
Conclusions:
- Laparoscopic ligation is a technically feasible and less invasive option for treating congenital portosystemic shunts in children.
- This minimally invasive approach can prevent potentially life-threatening late complications associated with these shunts.
Abstract:
Congenital portosystemic shunt is a rare clinical entity that may progress to jaundice, severe encephalopathy, and pulmonary hypertension and require surgical correction or coil embolization. We present a novel approach to the management of children with congenital portosystemic shunt by means of a minimally invasive surgical technique. Congenital portosystemic shunts were identified between the superior mesenteric vein and inferior vena cava in case 1 and between the splenic vein and left renal vein in case 2. Both of them were successfully ligated by laparoscopic approach, and catheters were subsequently replaced to monitor portal venous pressure. The patients tolerated the procedure well, and short-term results were excellent. Laparoscopic ligation of congenital portosystemic shunt is technically feasible and less invasive to the management of patients with congenital portosystemic shunts, preventing late onset, life-threatening complications.
