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Distal splenorenal shunt (DSS) in children: analysis of the first 21 consecutive cases
Insights
Distal splenorenal shunt (DSS) effectively treats esophageal hemorrhage in children. This surgical procedure demonstrates long-term shunt patency and cessation of bleeding, with no instances of hepatic encephalopathy in successful cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Vascular Surgery
Background:
- Esophageal hemorrhage is a serious complication in children.
- Distal splenorenal shunt (DSS) is a surgical option for managing such bleeding.
- Evaluating the efficacy and safety of DSS in pediatric patients is crucial.
Purpose of the Study:
- To assess the safety and effectiveness of distal splenorenal shunt (DSS) in treating esophageal hemorrhage in children.
- To evaluate shunt patency and long-term outcomes following DSS surgery.
- To investigate hemodynamic changes and collateralization patterns after DSS.
Main Methods:
- Twenty-one pediatric patients (ages 4-12) underwent distal splenorenal shunt (DSS) for esophageal hemorrhage.
- Patients were followed for 0.5 to 6 years post-operatively.
- Late angiographic studies were performed to assess shunt function and portal vein flow.
Main Results:
- Seventeen out of 21 patients achieved long-term shunt patency.
- Esophageal variceal hemorrhage ceased in all 17 successful cases.
- No cases of hepatic encephalopathy were observed in patients with successful shunts.
Conclusions:
- Distal splenorenal shunt (DSS) is a safe and effective surgical treatment for pediatric esophageal bleeding.
- The procedure demonstrates good long-term patency rates and prevents hepatic encephalopathy.
- DSS facilitates forward portal vein flow and significant portosystemic collateralization.
Abstract:
Twenty-one children from the ages of 4 to 12 years old were treated for esophageal hemorrhage by distal splenorenal shunt (DSS). In four patients, thrombosis of the shunt occurred within the first 24 hours after operation. In the other 17 children, long-term shunt patency was verified. Only one thrombosis has occurred in the last 15 consecutive cases. The patients were followed from one-half to six years. Late angiographic studies were performed in five patients. Forward flow through the portal vein was demonstrated in all patients. In addition, collateralization between the portomesenteric (PM) and gastrosplenic (GS) compartments was present in each case. In four patients with a wide-open shunt, the direction of collateral flow was from the PM to the GS compartment. In one child in whom the shunt was partially obstructed, the flow was from the GS to the PM compartment. In all 17 successful cases, esophageal variceal hemorrhage ceased, and there were no instances of hepatic encephalopathy. It is concluded that DSS is a safe and effective surgical procedure for the treatment of esophageal bleeding in children.