Evolution of portal hypertension surgery in children

Abstract

Introduction: Surgical portosystemic shunts (PSS) and Meso-Rex bypass (MRB) are both proven effective at treatment for portal hypertension in children, since the development of the MRB for extra hepatic portal vein obstruction (EHPVO) we have witnessed an evolution in the approach to this problem. The aim of this study is to evaluate the indication, patency and survival after these procedures. Methods: A retrospective analysis of children undergoing surgery for portal hypertension between 2008 to 2015. Results: 19 surgical shunts in 17 children. 8 female and 9 male with a mean age at surgery of 9y (1–18). Diagnosis were: EHPVO (10), congenital hepatic fibrosis (2), biliary atresia (1), cryptogenetic cirrhosis (3), portal vein stenosis after LDLT (1), thrombosis of previous MRB (2). We attempted 9 MRB and performed 7. 5 patients had a distal splenorenal shunt, 4 Proximal splenorenal, 1 splenocaval, 1 mesorenal, and 1 IMV to left renal vein. Three were occluded before the 6th months: 2 cases MRB and 1DSRS one month later on child transplanted 4 months later. The overall shunt occlusion is 26%. At last follow up all the patients are alive. Conclusions: We have seen an evolution in the therapy of portal hypertension in children, we as others believe that restoring flow by MRB should be the first line of treatment. MRB is not always functional due to intrahepatic anatomy or liver disease. PSS (selective when possible) are an excellent alternative for these cases and for children with chronic liver disease.