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Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
Surgical Treatment of Portal Hypertension in Children
Abdumanap Alkhasov1, Elena Komina1, Sergey Ratnikov1
1"National Medical Research Center for Children's Health" Federal State Autonomous Institution of the Russian Federation Ministry of Health, Moscow, Russia.
Insights
Surgical bypass procedures effectively treat pediatric portal hypertension, eliminating esophageal varices bleeding. Mesoportal shunting shows promise in restoring liver blood flow for extrahepatic cases.
Area of Science:
- Pediatric Surgery
- Hepatology
- Vascular Surgery
Background:
- Portal hypertension is a serious condition characterized by increased portal vein pressure, leading to complications like esophageal varices bleeding and splenomegaly.
- Current treatment goals for pediatric portal hypertension include preventing variceal bleeding and restoring intrahepatic blood flow.
- Extrahepatic portal hypertension is more common in children than intrahepatic forms.
Purpose of the Study:
- To evaluate the outcomes of surgical treatment for portal hypertension in children.
- To assess the effectiveness of various portosystemic bypass surgeries in preventing esophageal varices bleeding.
- To determine the impact of mesoportal shunting on restoring intrahepatic blood flow.
Main Methods:
- Retrospective analysis of 75 children (2019-2022) with portal hypertension.
- Surgical interventions included mesoportal, splenorenal, and mesocaval bypass procedures.
- Evaluation of complications, need for reoperation, and restoration of intrahepatic blood flow.
Main Results:
- All patients achieved a good outcome, with elimination of esophageal varices bleeding risk.
- Vascular bypass surgery was performed in all cases, with splenorenal bypass being the most common (49.3%).
- Mesoportal shunting in 18.6% of patients led to complete restoration of liver blood flow.
Conclusions:
- Portosystemic bypass surgery is an effective method for preventing esophageal varices bleeding in pediatric portal hypertension.
- Mesoportal shunting is a definitive treatment for extrahepatic portal hypertension, successfully restoring liver perfusion.
- Surgical intervention can significantly improve outcomes for children suffering from portal hypertension.
Abstract:
Portal hypertension is a syndrome characterized by increased pressure in the portal vein system and can be caused by impaired blood flow in the portal vein, hepatic veins, or inferior vena cava. The main complications of this condition are bleeding from varicose veins of the esophagus (in our study in 100% of patients), splenomegaly with hypersplenism (in our study in 98% of patients), ascites (in our study in 1 patient). The main goal of treating portal hypertension is to prevent bleeding from esophageal varices. However, today the goal of surgical treatment of portal hypertension in children is not only to prevent the development of bleeding but also the possible restoration of intrahepatic blood flow. A retrospective analysis of the results of treatment of portal hypertension in 75 children (41 boys, 34 girls) operated in our Center for the period from 2019 to 2022 was carried out. The mean age of the patients was 7 ± 1 years. Sixty-nine patients had an extrahepatic form of portal hypertension, and 6 patients had an intrahepatic form (liver fibrosis). In 14 patients (18.6%), the operation was repeated (a vascular shunt was previously applied in another hospital; 4 children were operated on repeatedly). A good result was obtained in all children, and the risk of bleeding from varicose veins of the esophagus was eliminated. Vascular bypass surgery was performed in all cases: mesoportal bypass in 17 (22.7%) patients, splenorenal bypass in 37 (49.3%) patients, mesocaval bypass in 21 (28%) patients. In 10 (13%) cases, repeated bypass surgery was required due to dysfunction or thrombosis of the previously performed bypass. In 14 (18.6%) patients with mesoportal shunts, blood flow in the liver was completely restored. The main method of surgical treatment of portal hypertension today is portosystemic bypass surgery, which effectively prevents bleeding from varicose veins of the esophagus. Mesoportal shunting is a definitive treatment for extrahepatic portal hypertension that restores portal perfusion of the liver.
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