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Updated: May 20, 2026
Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
Surgical management of portal hypertension in children
Jean de Ville de Goyet1, Giuseppe D'Ambrosio, Chiara Grimaldi
1Department of Paediatric Surgery and Transplantation, Bambino Gesù Children's Hospital, Rome, Italy. jean.devilledegoyet@opbg.net
Insights
Management of pediatric portal hypertension has improved due to better endoscopic variceal control and liver transplants. Emergency shunts are rare, with most bleeding managed endoscopically.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Surgical Innovation
Background:
- Portal hypertension management in children has evolved significantly over the last decade.
- Improved outcomes are attributed to advancements in endoscopic techniques and liver transplantation success.
Purpose of the Study:
- To review the current strategies for managing pediatric portal hypertension.
- To highlight the shift from emergency surgical shunts to less invasive interventions.
Main Methods:
- Review of recent literature and clinical practice guidelines.
- Analysis of the efficacy of endoscopic variceal control and liver transplantation.
- Evaluation of the role of interventional radiology and surgical shunts.
Main Results:
- Endoscopic management and liver transplantation are primary treatments for pediatric portal hypertension.
- Emergency surgical shunts are seldom required; interventional radiology is an option for adults.
- Nontransplant interventions, including the meso-Rex bypass, are valuable for specific cases, particularly noncirrhotic portal hypertension.
Conclusions:
- Modern management emphasizes endoscopic and transplant-based approaches for pediatric portal hypertension.
- Surgical and radiological interventions are reserved for specific indications or refractory cases.
- The meso-Rex bypass offers a viable option for select pediatric patients.
Abstract:
The management of children with portal hypertension has dramatically changed during the past decade, with an improvement in outcome. This has been achieved by improved efficiency of endoscopic variceal control and the success of liver transplantation. Emergency surgical shunt procedures are rarely required, with acute bleeding episodes generally controlled endoscopically or, occasionally in adults, by interventional radiological procedures. Portosystemic shunts may be considered as a bridge to transplant in adults but are rarely used in this context in children. Nontransplant surgery or radiological interventions may still be indicated for noncirrhotic portal hypertension when the primary cause can be cured and to allow normalization of portal pressure before liver parenchyma is damaged by chronic secondary changes in some specific diseases. The meso-Rex bypass shunt is used widely but is limited to those with a favorable anatomy and can even be performed preemptively. Elective portosystemic shunt surgery is reserved for failure to respond to conservative management in the absence of alternative therapies.
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