Distal Splenorenal Shunt (DSRS) in Children with Extrahepatic Portal Hypertension
1Section of Vascular Surgery, Department of Surgery, The Aga Khan University Hospital (AKUH), Karachi, Pakistan.
Insights
Distal Spleno-Renal Shunt (DSRS) offers a safe and effective treatment for children with portal hypertension and gastrointestinal bleeding, especially in resource-limited areas lacking endoscopic facilities.
Area of Science:
- Pediatric Surgery
- Hepatology
- Gastroenterology
Background:
- Portal hypertension (PH) is rare in children, with endoscopic variceal ablation as the standard treatment.
- Endoscopic facilities are often unavailable in resource-limited settings, posing a challenge for pediatric PH management.
- Extrahepatic portal hypertension can lead to recurrent gastrointestinal bleeding and hypersplenism.
Purpose of the Study:
- To evaluate the safety and efficacy of Distal Spleno-Renal Shunt (DSRS) in pediatric patients with recurrent gastrointestinal bleeding due to portal hypertension.
- To assess DSRS as an alternative treatment in resource-limited settings.
- To analyze indications, operative outcomes, shunt patency, and re-bleeding episodes following DSRS.
Main Methods:
- A retrospective review of nine pediatric patients (age 6-16 years) who underwent DSRS for refractory gastrointestinal bleeding and hypersplenism.
- Data collection included indications for surgery, operative morbidity and mortality, shunt patency, and re-bleeding rates.
- Patients had failed or were unsuitable for endoscopic treatment.
Main Results:
- DSRS was found to be a safe procedure with acceptable operative morbidity and mortality in this pediatric cohort.
- The study demonstrated good shunt patency rates following DSRS.
- DSRS effectively prevented re-bleeding episodes and improved hypersplenism in the treated patients.
Conclusions:
- Distal Spleno-Renal Shunt (DSRS) is a viable and effective alternative treatment for pediatric portal hypertension in resource-limited settings.
- DSRS successfully manages recurrent gastrointestinal bleeding and hypersplenism when endoscopic treatments are not feasible.
- This surgical approach provides a crucial option for improving outcomes in children with extrahepatic portal hypertension.
Abstract:
Portal hypertension (PH) is infrequent in children as compared to adults. Currently, repetitive endoscopic ablation of varices is standard treatment. However, endoscopic facilities are not readily available in resource-limited settings. We reviewed the indications, operative morbidity, mortality, shunt patency and re-bleeding episodes in nine patients (age range 6-16 years, M:F 6:3) who had DSRS for recurrent GI bleeding not responding to endoscopic treatment and hypersplenism. DSRS is a safe and effective treatment alternative in resource limiting setting for preventing bleeding and improving hypersplenism in children with extrahepatic portal hypertension.
