DISTAL SPLENORENAL SHUNT IN SURGICAL TREATMENT OF PORTAL HYPERTENSION IN CHILDREN

Abstract

Background. Management of pediatric patients with portal hypertension (PH) has evolved considerably in recent years. Physiologic shunts and successful liver transplant has changed the paradigm of portal hypertension surgery. However, pediatric patients with noncirrhotic causes of PH and unfavorable anatomy, and patients with cirrhotic causes require other radical surgical approaches. There is a lack of publications on pediatric cohorts in which other surgical procedures, including DSRS, was performed. Aim: to analyze effectiveness of DSRS in treatment of most dangerous PH symptoms: esophageal varices grade and bleeding episodes recurrence, splenomegaly, thrombocytopenia and anemia, and to assess DSRD survival in different groups of patients. Materials and methods. A single-center retrospective study was performed. In 37 children underwent distal splenorenal shunt (DSRS) was performed in the period from January 2011 to January 2022. The mean follow-up period was 55.4±6.1 months. Results. Patients of the study group (n=37,100%) were divided into two groups according to etiological factor, that caused PH: 29 (78.3%) were diagnosed EHPVO, and 8 (21.7%) – HPH. Comparison showed difference in spleen volume (p=0.009) and follow-up duration (p=0.001). DSRS resolved thrombocytopenia, anemia and decreased the spleen size in all the patients, platelets count increase in patients of both EHPVO (p=0.009) and HPH patients (p=0.021) and hemoglobin level increase in EHPVO patients (p=0.037). Varices grade comparison showed involution in both groups (p<0,001). However, DSRS dysfunction was observed in 8 (28.5%) patients from EHPVO group and in 1(12.5%) in HPH group. DSRS survival in EHPVO patients was assessed 0.309 (95%CI 0.0186-0.708) with no difference in overall shunt survival between groups. Conclusion. DSRS showed good results in resolving dangerous symptoms of PH in both study groups with non-cirrhotic (EHPVO) and cirrhotic (HPH) causes of PH, with significant thrombocyte count increase and varices grade involution. However, despite no difference was found in DSRS survival between study groups, DSRS survival in patients with EHPVO reached median survival by 136 months.