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Updated: Jan 18, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Novel Bedside Ligation for Staged Closure of Congenital Portosystemic Shunts: A Single-Center Experience in 20
Sheng Chen1,2, Huaying Zhao1, Zhoulonglong Xie1
1Department of General Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Objective:
To report our institutional experience with a portal venous pressure (PVP)-guided surgical strategy for congenital portosystemic shunts (CPSs) and introduce a novel bedside ligation technique for staged shunt closure.
Methods:
We retrospectively reviewed 20 children who underwent surgical CPS closure between 2013 and 2023. The surgical approach was determined by intraoperative PVP during temporary shunt occlusion. One-stage ligation was performed when PVP remained < 25 mm Hg, whereas shunts with PVP ≥ 25 mm Hg were banded for staged closure using either bedside ligation or endovascular completion.
Results:
Fourteen patients (70%) underwent one-stage closure (median PVP: 22.0 mm Hg, interquartile range [IQR]: 18.0-22.5), and six (30%) required two-stage closure (median PVP: 28.0 mm Hg, IQR: 25.8-29.5). Among the latter, five achieved complete shunt occlusion through the bedside technique, avoiding reoperation or readmission. The primary composite outcome-radiologic closure, fasting blood ammonia normalization, and absence of severe complications-was achieved in all 20 patients (100%) at 1-year follow-up. Significant intrahepatic portal vein (IPV) remodeling was observed, with median left and right IPV diameters increasing from 1.4 and 1.6 to 4.8 and 5.0 mm, respectively (both p < 0.0001). The overall complication rate was 15% (3/20), all Clavien-Dindo Grades I to II.
Conclusion:
In children with CPSs unsuitable for endovascular closure, a PVP-guided surgical strategy appears safe and effective. For those requiring two-stage closure due to elevated PVP, bedside ligation after Endoloop banding provides a feasible, less invasive alternative to reoperation. However, larger studies are needed to confirm its safety and efficacy.
