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Proximal splenorenal shunts for extrahepatic portal venous obstruction in children
1Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi.
Insights
Proximal splenorenal shunt is an effective treatment for children with extrahepatic portal venous obstruction in India. This one-time procedure offers low mortality and good long-term survival rates.
Area of Science:
- Pediatric Surgery
- Hepatology
- Vascular Surgery
Background:
- Extrahepatic portal venous obstruction (EHPVO) is a common cause of portal hypertension in Indian children.
- Endoscopic sclerotherapy is increasingly preferred over proximal splenorenal shunt (PSS) due to perceived high risks.
- PSS may be a more suitable definitive treatment for children with limited access to medical facilities.
Purpose of the Study:
- To evaluate the outcomes of proximal splenorenal shunts in children with EHPVO.
- To assess the efficacy and safety of PSS as a treatment for pediatric portal hypertension.
Main Methods:
- A retrospective analysis of 160 children who underwent PSS between 1976 and 1992.
- Procedures included 20 emergency shunts for uncontrollable bleeding and 140 elective shunts for recurrent bleeding or hypersplenism.
Main Results:
- Overall operative mortality was 1.9% (3/160), with 10% (2/20) for emergency and 0.7% (1/140) for elective procedures.
- Rebleeding occurred in 11% (17/160) of patients; no cases of portosystemic encephalopathy were observed.
- The 15-year survival rate was 95%, indicating good long-term outcomes.
Conclusions:
- Proximal splenorenal shunt is a safe and effective one-time procedure for children in India with EHPVO.
- The study demonstrates low mortality and favorable long-term results, supporting PSS as a viable treatment option.
Objective:
The results of proximal splenorenal shunts done in children with extrahepatic portal venous obstruction were evaluated.
Summary Background Data:
Extrahepatic portal venous obstruction, a common cause of portal hypertension in children in India, is being treated increasingly by endoscopic sclerotherapy instead of by proximal splenorenal shunt. It is believed that surgery (or the operation) carries high mortality and rebleeding rates and is followed by portosystemic encephalopathy and postsplenectomy sepsis. However, a proximal splenorenal shunt is a definitive procedure that may be more suitable for children, particularly those who have limited access to medical facilities and safe blood transfusion.
Methods:
Between 1976 and 1992, the authors performed 160 splenorenal shunts in children. Twenty were emergency procedures for uncontrollable bleeding and 140 were elective procedures--102 for recurrent bleeding and 38 for hypersplenism.
Results:
The overall operative mortality rate was 1.9%--10% (3/160-2/20) after emergency operations and 0.7% (1/140) after elective operations. Rebleeding occurred in 17 patients (11%), and pneumococcal meningitis developed in 1 patient who recovered later. Encephalopathy did not develop in any patient. Four patients died in the follow-up period--two of rebleeding, one of chronic renal failure and a subphrenic abscess, and one of unknown causes. The 15-year survival rate by life table analysis was 95%.
Conclusions:
A proximal splenorenal shunt, a one-time procedure with a low mortality rate and good long-term results, is an effective treatment for children in India with extrahepatic portal venous obstruction.