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Extrahepatic portal hypertension: quality of life and somatic growth after surgery
P Menon1, K L N Rao, A Bhattacharya
1Department of Pediatric Surgery, Post-Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Elective surgery significantly improves growth and quality of life in children with extrahepatic portal hypertension. Surgical intervention for portal hypertension is also more cost-effective than medical management.
Area of Science:
- Pediatric Surgery
- Hepatology
- Gastroenterology
Background:
- Extrahepatic portal hypertension (EHPHT) presents challenges in pediatric growth and quality of life.
- Medical management alone may not fully address the long-term consequences of EHPHT.
Purpose of the Study:
- To evaluate the impact of elective surgery on growth parameters and quality of life in children with EHPHT.
- To compare surgical outcomes based on different surgical techniques.
Main Methods:
- Prospective study of 30 children with EHPHT undergoing surgery (1999-2002).
- Assessment of height and weight Z scores pre- and post-surgery.
- Evaluation of quality of life through scholastic ability, physical activity, and social interaction.
Main Results:
- 50% and 76% improvement in weight and height Z scores, respectively, after surgery.
- Significant improvements in scholastic ability (85%), physical activity (85%), and personality (73%).
- Surgical intervention, particularly splenectomy with devascularization or central splenorenal shunt, showed better outcomes.
Conclusions:
- Surgical intervention for EHPHT leads to significant improvements in pediatric growth parameters.
- Enhanced quality of life, including academic and social aspects, is observed post-surgery.
- Surgery offers a cost-effective, one-time solution for EHPHT in developing countries.
Aim:
This study was carried out in order to determine whether children with extrahepatic portal hypertension show any improvement in growth parameters and quality of life after elective surgery.
Patients And Methods:
All patients with extrahepatic portal hypertension who underwent surgery between April 1999 and March 2002 were studied prospectively. Height and weight before and after surgery were converted into Z scores for comparison. The quality of life was assessed by changes in scholastic ability, physical activity, social interaction, and economic effects on the family.
Results:
At the end of a minimum follow-up period of 1 year, of the 30 children, 50 % and 76 % showed improvement in weight and height Z scores, respectively, compared to their scores while on medical management. Z scores below - 2 SD for weight and height were seen in 57 % and 37 % of patients prior to surgery, and only in 40 % and 20 %, respectively at the end of follow-up, which ranged from 1 - 4 years. The improvement in height and weight was more in those who had undergone splenectomy with either devascularization or central splenorenal shunt compared to those who had undergone side-to-side lienorenal shunt without splenectomy. The children, who had dropped out of school while on medical management, either rejoined school or attended vocational courses after surgery. There was an improvement in school performance and physical activity in 85 % of the children. Improvement in personality was seen in 73 % of the affected patients. The cost incurred for surgery was one-third of the amount spent while on medical management.
Conclusions:
Growth parameters improved significantly in children after surgical intervention for portal hypertension. Overall improvement in scholastic abilities, physical activity, and social interaction was noted in a majority of the patients. As a one-time procedure in a developing country, surgery is also more cost effective.
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