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[Therapy of portal hypertension in childhood]
Insights
Sclerotherapy for pediatric portal hypertension led to bleeding recurrences and stenosis. Distal splenorenal shunt (Warren) surgery resulted in no bleeding recurrences, with manageable complications.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Surgical Interventions
Background:
- Portal hypertension in children presents significant challenges.
- Prehepatic blockage is a common etiology in pediatric cases.
- Effective management strategies are crucial for preventing complications like bleeding.
Purpose of the Study:
- To evaluate the efficacy and outcomes of sclerotherapy versus distal splenorenal shunt (Warren) in treating pediatric portal hypertension.
- To compare complication rates and long-term success between the two treatment modalities.
Main Methods:
- Retrospective analysis of 48 children treated for portal hypertension between 1980 and 1984.
- Sclerotherapy performed in 19 children.
- Distal splenorenal shunt (Warren) performed in 16 children.
Main Results:
- Sclerotherapy resulted in bleeding recurrences (7/19) and esophageal stenosis (2/19).
- Distal splenorenal shunt (Warren) surgery had a 100% survival rate.
- Post-operative complications for shunt surgery included pneumonia (1) and pancreatitis (1).
- Shunt obstruction occurred in 4 cases, but no bleeding recurrences were observed post-shunt surgery.
Conclusions:
- Distal splenorenal shunt (Warren) surgery appears to be a more effective long-term solution for preventing bleeding recurrences in pediatric portal hypertension compared to sclerotherapy.
- While shunt surgery carries risks of obstruction and other complications, it offers better control of variceal bleeding.
Abstract:
From 1980 to 1984 fortyeight children with portal hypertension were treated, 37 out of these had a prehepatic bloc. In 19 children a sclerotherapy was performed. Seven times a bleeding recurrency occurred and an esophageal stenosis was seen in 2 cases. The distal splenorenal shunt (Warren) was performed 16 times. All children survived, one pneumonia and one slight pancreatitis were observed post-operatively. Four times a shunt obstruction was found at follow-up examinations. Bleeding recurrencies did not appear.