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Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
Surgery for portal hypertension in children: A 12-year review
1Department of Paediatric Surgery, University of the Witwatersrand, Johannesburg, South Africa. gertrude@hmpg.co.za.
Insights
Shunt surgery is a safe and effective treatment for children with portal hypertension, particularly for those with non-cirrhotic conditions or when conservative methods fail. This surgical approach addresses complications like gastrointestinal bleeding.
Area of Science:
- Pediatric Surgery
- Hepatology
- Vascular Surgery
Background:
- Portal hypertension is a serious condition in children, often requiring intervention.
- While non-surgical options exist, surgical management remains crucial for select pediatric cases.
- This study reviews 12 years of experience with shunt surgery for pediatric portal hypertension.
Purpose of the Study:
- To detail the patient profile, surgical indications, and outcomes of shunt surgery in pediatric portal hypertension.
- To analyze the types of shunt procedures performed and their associated complications.
- To evaluate the safety and efficacy of surgical intervention for this condition.
Main Methods:
- Retrospective review of 12 pediatric patients undergoing shunt surgery between 2005 and 2017.
- Analysis of patient demographics, indications for surgery, surgical procedures, and postoperative outcomes.
- Documentation of complications, including mortality, shunt thrombosis, and anastomotic strictures.
Main Results:
- Fourteen procedures were performed on 12 children (median age 6.5 years).
- Gastrointestinal bleeding unresponsive to endoscopic therapy was the primary indication.
- Portal vein thrombosis was the most common etiology; distal splenorenal shunt (58%) and meso-portal bypass (Rex shunt, 33%) were the main procedures.
- Outcomes included one mortality, one instance of shunt thrombosis requiring revision, and two anastomotic strictures.
Conclusions:
- Shunt surgery is a safe and vital treatment for pediatric non-cirrhotic portal hypertension.
- It is indicated for children with adequate hepatic reserve who do not respond to conservative management.
- Surgical intervention effectively manages severe side effects of portal hypertension in children.
Background:
Portal hypertension is a common and potentially devastating condition in children. Notwithstanding advances in the nonsurgical management of portal hypertension, surgery remains an important treatment modality in select patients. We report here on our experience in the past 12 years.
Objectives:
To describe the profile of, indication for, and complications of shunt surgery in children with portal hypertension.
Methods:
Twelve children underwent shunt surgery between 2005 and 2017. Patient records were reviewed.
Results:
Fourteen procedures were performed on 12 patients during the study period. The median age at surgery was 6.5 (range 1 - 18) years. Six patients were male. Gastrointestinal bleeding that was not amenable to endoscopic control was the most common indication for surgery. Portal vein thrombosis was the most common cause of portal hypertension in our series (n=11). Two-thirds (8/12) of all patients had an identifiable underlying risk factor for portal vein thrombosis. One-third of all patients (4/12) underwent a meso-portal bypass procedure (Rex shunt), while 58% (7/12) were managed with a distal splenorenal shunt. All patients received postoperative thromboprophylaxis. We experienced a single mortality, 1 patient experienced shunt thrombosis that required revision shunt surgery, and 2 patients experienced anastomotic strictures, with one being managed with revision surgery and the other currently awaiting radiological venoplasty.
Conclusions:
Surgery is a safe and important tool in the management of children with non-cirrhotic portal hypertension and those with sufficient hepatic reserve who fail to respond to more conservative methods for the treatment of side effects of portal hypertension.
