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Non-conventional portosystemic shunts in children with extrahepatic portal vein obstruction
A J D'Cruz1, P S Kamath, C Ramachandra
1Department of Pediatric Surgery, St John's Medical College Hospital, Bangalore, India.
Insights
Non-conventional shunts offer beneficial results for children with extrahepatic portal vein obstruction and portal hypertension. These procedures showed no postoperative mortality in a study of 48 children.
Area of Science:
- Pediatric Surgery
- Vascular Surgery
- Gastroenterology
Background:
- Extrahepatic portal vein obstruction (EHPVO) frequently causes portal hypertension and variceal hemorrhage in children.
- Selective shunts are the preferred treatment, but anatomical variations can preclude their use.
Observation:
- Fifty surgical procedures were performed on 48 children with portal hypertension due to EHPVO between 1987 and 1992.
- Four children required non-conventional shunts due to unavailability of standard vessels for anastomosis.
Findings:
- No postoperative mortality was observed in any of the 50 procedures.
- One patient experienced recurrent gastrointestinal hemorrhage, attributed to shunt stenosis and incomplete coronary vein ligation.
- No rebleeding occurred in the remaining patients during follow-up of at least 18 months.
Implications:
- Non-conventional shunts are a viable and effective option for selected pediatric patients with EHPVO when standard shunts are not feasible.
- These findings support the use of tailored surgical approaches to manage complex cases of pediatric portal hypertension.
Abstract:
Portal hypertension due to extrahepatic portal vein obstruction is ideally treated by the use of a selective shunt. In a four year period between July 1987 and June 1992, 50 surgical procedures were carried out in 48 children with portal hypertension-related variceal hemorrhage. The portal, splenic, mesenteric, or coronary vein was not available for anastomosis in four children who, therefore, underwent non-conventional shunts which are described here. There was no postoperative mortality. One patient had a repeat gastrointestinal hemorrhage, probably due to stenosis of the shunt and failure to ligate the coronary vein. No rebleeding occurred on follow-up of at least 18 months. We conclude that in selected children requiring surgery for portal hypertension due to extrahepatic portal venous obstruction, a non-conventional shunt may be used with beneficial results.