This journal is
indexed in Scopus
Year 2021 Vol. 29 No 5
THE EFFECTIVENESS OF SPLENORENAL SHUNT IN TREATMENT OF PREHEPATIC PORTAL HYPERTENSION IN CHILDREN
Bogomolets National Medical University,
National Children’s Specialized Hospital “Okhmatdet”, Kiev,
Objective. To evaluate the results of treatment of prehepatic portal hypertension (PPH) in children by method of side-to-side splenorenal bypass.
Methods. A retrospective, monocentric analysis of 114 patients with prehepatic portal hypertension was carried out in the period from 2000 to 2018. The age of the patients was from 6 months up to 18 years, the average age 10,1±3,8 years (M±σ). All patients underwent side-to-side splenorenal shunt. In the postoperative period, on the 7th day, ultrasound examination of the abdominal organs with Doppler sonography (US) was performed to assess the volume of the spleen, the rate of portohepatic perfusion, the rate of blood flow along the side-to-side splenorenal shunt, as well as to assess its diameter. Control US was performed after the 1st, 3rd, 6th, 12th months; to assess the regression of esophageal and gastric varicose veins, the control esophagogastroduodenoscopy (EYD) was performed after 3rd , 6th, 12th months and then once a year. Subsequently, the control examination of the patients was carried out once a year. The follow-up was 2-18 years.
Results. Out of 114 patients who underwent side – to – side splenorenal shunt, 5 (4,4%) patients had recurrent bleeding from the esophageal variceal vein at the follow-up period (2-18 years). One patient had intra-abdominal arrosive bleeding from side-to-side splenorenal shunt provoked by severe postoperative pancreatitis. The average diameter of the shunt was 12±1.9 mm. The spleen volume decreased by 39.7±10.3%. Portohepatic perfusion reduced by 39% in comparison with the indicators before surgery. The blood flow rate along the side –to-side splenorenal shunt was 2403±557.3 ml/min. in 95,4% of patients the regression of variceal vein was noted. Hypersplenism syndrome was arrested in 73.6% of children.
Conclusion. Side -to- side splenorenal shunt is considered to be an effective method of portal decompression with the effectiveness in preventing both esophageal and gastric variceal veins bleeding in 95,4% of patients.
- de Franchis R. Expanding consensus in portal hypertension report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63(3):743-52. doi: 10.1016/j.jhep.2015.05.022
- Di Salvo Neil, Maffi Michela, Lima Mario. Portal Hypertension in Children. In: Lima M, ed. Pediatric Digestive Surgery. Springer International Publishing; 2017. p. 373-88. doi: 10.1007/978-3-319-40525-4
- Aleksandrov AE, Shavrov AA, Seniakovich VM, Leont’ev AF. Klinika, diagnostika i khirurgicheskoe lechenie detei s portal’noi gipertenziei. Pediatriia. 1999;(2):19-21 (In Russ).
- Shneider BL, Bosch J, de Franchis R, Emre SH, Groszmann RJ, Ling SC, Lorenz JM, Squires RH, Superina RA, Thompson AE, Mazariegos GV; expert panel of the Children’s Hospital of Pittsburgh of UPMC. Portal hypertension in children: expert pediatric opinion on the report of the Baveno v Consensus Workshop on Methodology of Diagnosis and Therapy in Portal Hypertension. Pediatr Transplant. 2012 Aug;16(5):426-37. doi: 10.1111/j.1399-3046.2012.01652.x
- Triana Junco P, Alvarez A, Dore M, Jimenez Gomez J, Sánchez Galán A, Vilanova-Sánchez A, Andres A, Encinas JL, Martinez L, Hernandez F, Lopez Santamaria M. Long-Term Results after Diversion Surgery in Extrahepatic Portal Vein Obstruction. Eur J Pediatr Surg. 2019 Feb;29(1):23-27. doi: 10.1055/s-0038-1668147
- Lautz TB, Keys LA, Melvin JC, Ito J, Superina RA. Advantages of the meso-Rex bypass compared with portosystemic shunts in the management of extrahepatic portal vein obstruction in children. J Am Coll Surg. 2013 Jan;216(1):83-89. doi: 10.1016/j.jamcollsurg.2012.09.013
- Shun A, Delaney DP, Martin HC, Henry GM, Stephen M. Portosystemic shunting for paediatric portal hypertension. J Pediatr Surg. 1997 Mar;32(3):489-93. doi: 10.1016/s0022-3468(97)90613-8
- Shinde S, Gopalan S, Kandpal DK, Chowdhary SK. Mitra shunt (spleen preserving, side to side lieno-renal shunt) for portal hypertension with hypersplenism in early infancy. J Indian Assoc Pediatr Surg. 2014 Apr;19(2):96-99. doi: 10.4103/0971-9261.129604
- Khanna R, Sarin SK. Idiopathic portal hypertension and extrahepatic portal venous obstruction. Hepatol Int. 2018 Feb;12(Suppl 1):148-67. doi: 10.1007/s12072-018-9844-3
- El-Karaksy HM, El-Koofy N, Mohsen N, Helmy H, Nabil N, El-Shabrawi M. Extrahepatic portal vein obstruction in Egyptian children. J Pediatr Gastroenterol Nutr. 2015 Jan;60(1):105-9. doi: 10.1097/MPG.0000000000000548
- Ling SC. Portal hypertension in children. Clin Liver Dis (Hoboken). 2012 Nov 9;1(5):139-42. doi: 10.1002/cld.79. eCollection 2012 Nov.
- Rao KL, Goyal A, Menon P, Thapa BR, Narasimhan KL, Chowdhary SK, Samujh R, Mahajan JK. Extrahepatic portal hypertension in children: observations on three surgical procedures. Pediatr Surg Int. 2004 Sep;20(9):679-84. doi: 10.1007/s00383-004-1272-x
- Pal S, Mangla V, Radhakrishna P, Sahni P, Pande GK, Acharya SK, Chattopadhyay TK, Nundy S. Surgery as primary prophylaxis from variceal bleeding in patients with extrahepatic portal venous obstruction. J Gastroenterol Hepatol. 2013 Jun;28(6):1010-14. doi: 10.1111/jgh.12123
- Pande GK, Reddy VM, Kar P, Sahni P, Berry M, Tandon BN, Nundy S. Operations for portal hypertension due to extrahepatic obstruction: results and 10 year follow up. Br Med J (Clin Res Ed). 1987 Oct 31;295(6606):1115-17. doi: 10.1136/bmj.295.6606.1115
- Orloff MJ, Orloff MS, Girard B, Orloff SL. Bleeding esophagogastric varices from extrahepatic portal hypertension: 40 years’ experience with portal-systemic shunt. J Am Coll Surg. 2002 Jun;194(6):717-28; discussion 728-30. doi: 10.1016/s1072-7515(02)01170-5
- Lillegard JB, Hanna AM, McKenzie TJ, Moir CR, Ishitani MB, Nagorney DM. A single-institution review of portosystemic shunts in children: an ongoing discussion. HPB Surg. 2010;2010:964597. doi: 10.1155/2010/964597
- Haller JD, Glick H, Hallman GL, Cooley DA. Portal decompression by side-to-side splenorenal venous anastomosis. Results in 14 patients. Arch Surg. 1971 Apr;102(4):316-21. doi: 10.1001/archsurg.1971.01350040078015
- Aliev MM, Yuldashev RZ, Adilova GS, Yusupaileva GA. Renal blood flow before and after portosystemic shunt in children with portal hypertension. Pediatr Surg Int. 2014 Mar;30(3):295-99. doi: 10.1007/s00383-014-3463-4
Kiev, st. V. Chornovol 28/1,
National Children’s Specialized Hospital “Okhmatdet”,
Department of Urgent Surgery,
tel.: +38 067 270-93-23,
Zhezhera Roman V.
Zhezhera Roman V., Graduate Student of the Department of Pediatric Surgery, Bogomolets National Medical University, Pediatric Surgeon of the Department of Urgent Surgery, National Children’s Specialized Hospital “Okchmatdet”.