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Portal venous decompression with H-type mesocaval shunt using autologous vein graft: a North American experience.
J Pediatr Surg. 2001 Jan; 36(1):91-6.JP

Abstract

BACKGROUND/PURPOSE

Portal hypertension in children often is caused by prehepatic venous obstruction or intrahepatic fibrosis without cirrhosis. This situation is uniquely amenable to shunting; this report details the experience of 3 North American centers with an H-type mesocaval shunt using autologous vein, which has been widely used in European centers.

METHODS

Retrospective chart review was conducted of records from 1980 through 1999 at 3 North American institutions. Charts were reviewed for etiology of portal hypertension, diagnostic workup, preoperative management, operative results and complications, postoperative shunt patency, patient well-being, and eventual need for liver transplantation.

RESULTS

Twenty patients were identified with prehepatic causes of venous obstruction undergoing shunt therapy. Eleven had portal venous thrombosis or cavernous transformation. Of these, 3 had umbilical catheters placed in the neonatal period. Five children had American-Indian cirrhosis, 1 had congenital hepatic fibrosis, and 3 had hepatic fibrosis associated with polycystic kidney disease. Patients presented at a median age of 3.7 years and underwent follow-up for an average of 4.3 years after surgery. These patients had an average of 3.6 bleeding episodes, (with 3.9 attempts at sclerotherapy) and received 3 units of blood preoperatively. Average age at operation was 8 years, average weight was 30 kg, and perioperative blood requirement was 200 mL. In general, patients did well postoperatively; 2 patients required reoperation for lymphatic leaks, and there was 1 death caused by a leaking G-tube, unrelated to shunt functioning. Two patients had transient encephalopathy postoperatively, and 1 patient had severe pancreatitis. All shunts remain patent, with good function and no further bleeding.

CONCLUSIONS

These results are encouraging, and we would suggest that the H-type mesocaval shunt utilizing autologous vein be considered for wider use in pediatric patients with prehepatic cause of portal hypertension. An algorithm for the work-up of pediatric patients with variceal bleeding is presented, with the recommendation that shunt surgery be considered early in patients with a prehepatic or fibrotic causes of portal hypertension.

Authors+Show Affiliations

Sigalet DL
Alberta Children's Hospital, Calgary, Alberta, and Hopital Sainte-Justine, Montreal, Quebec.
Mayer S
No affiliation info available
Blanchard H
No affiliation info available

MeSH

AlgorithmsChildChild, PreschoolFemaleHumansHypertension, PortalInfantJugular VeinsMalePortasystemic Shunt, SurgicalRetrospective StudiesTransplantation, AutologousTreatment OutcomeVascular Patency

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11150444

Citation

Sigalet, D L., et al. "Portal Venous Decompression With H-type Mesocaval Shunt Using Autologous Vein Graft: a North American Experience." Journal of Pediatric Surgery, vol. 36, no. 1, 2001, pp. 91-6.
Sigalet DL, Mayer S, Blanchard H. Portal venous decompression with H-type mesocaval shunt using autologous vein graft: a North American experience. J Pediatr Surg. 2001;36(1):91-6.
Sigalet, D. L., Mayer, S., & Blanchard, H. (2001). Portal venous decompression with H-type mesocaval shunt using autologous vein graft: a North American experience. Journal of Pediatric Surgery, 36(1), 91-6.
Sigalet DL, Mayer S, Blanchard H. Portal Venous Decompression With H-type Mesocaval Shunt Using Autologous Vein Graft: a North American Experience. J Pediatr Surg. 2001;36(1):91-6. PubMed PMID: 11150444.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Portal venous decompression with H-type mesocaval shunt using autologous vein graft: a North American experience. AU - Sigalet,D L, AU - Mayer,S, AU - Blanchard,H, PY - 2001/1/11/pubmed PY - 2001/6/2/medline PY - 2001/1/11/entrez SP - 91 EP - 6 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 36 IS - 1 N2 - BACKGROUND/PURPOSE: Portal hypertension in children often is caused by prehepatic venous obstruction or intrahepatic fibrosis without cirrhosis. This situation is uniquely amenable to shunting; this report details the experience of 3 North American centers with an H-type mesocaval shunt using autologous vein, which has been widely used in European centers. METHODS: Retrospective chart review was conducted of records from 1980 through 1999 at 3 North American institutions. Charts were reviewed for etiology of portal hypertension, diagnostic workup, preoperative management, operative results and complications, postoperative shunt patency, patient well-being, and eventual need for liver transplantation. RESULTS: Twenty patients were identified with prehepatic causes of venous obstruction undergoing shunt therapy. Eleven had portal venous thrombosis or cavernous transformation. Of these, 3 had umbilical catheters placed in the neonatal period. Five children had American-Indian cirrhosis, 1 had congenital hepatic fibrosis, and 3 had hepatic fibrosis associated with polycystic kidney disease. Patients presented at a median age of 3.7 years and underwent follow-up for an average of 4.3 years after surgery. These patients had an average of 3.6 bleeding episodes, (with 3.9 attempts at sclerotherapy) and received 3 units of blood preoperatively. Average age at operation was 8 years, average weight was 30 kg, and perioperative blood requirement was 200 mL. In general, patients did well postoperatively; 2 patients required reoperation for lymphatic leaks, and there was 1 death caused by a leaking G-tube, unrelated to shunt functioning. Two patients had transient encephalopathy postoperatively, and 1 patient had severe pancreatitis. All shunts remain patent, with good function and no further bleeding. CONCLUSIONS: These results are encouraging, and we would suggest that the H-type mesocaval shunt utilizing autologous vein be considered for wider use in pediatric patients with prehepatic cause of portal hypertension. An algorithm for the work-up of pediatric patients with variceal bleeding is presented, with the recommendation that shunt surgery be considered early in patients with a prehepatic or fibrotic causes of portal hypertension. SN - 0022-3468 UR - https://www.unboundmedicine.com/medline/citation/11150444/Portal_venous_decompression_with_H_type_mesocaval_shunt_using_autologous_vein_graft:_a_North_American_experience_ DB - PRIME DP - Unbound Medicine ER -