Novosti
Khirurgii

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Year 2021 Vol. 29 No 5

PEDIATRIC SURGERY

R.V. ZHEZHERA

THE EFFECTIVENESS OF SPLENORENAL SHUNT IN TREATMENT OF PREHEPATIC PORTAL HYPERTENSION IN CHILDREN

Bogomolets National Medical University,
National Children’s Specialized Hospital “Okhmatdet”, Kiev,
Ukraine

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.

Keywords: portal hypertension, prehepatic type, splenorenal bypass, children, variceal veins, gastrointestinal bleeding
p. 565-572 of the original issue
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Address for correspondence:
01135, Ukraine,
Kiev, st. V. Chornovol 28/1,
National Children’s Specialized Hospital “Okhmatdet”,
Department of Urgent Surgery,
tel.: +38 067 270-93-23,
e-mail: roman.zhezhera83@gmail.com,
Zhezhera Roman V.
Information about the authors:
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”.
https://orcid.org/0000-0003-3000-0821
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