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[Porto-systemic shunts in children: Schneider Children's Medical Center experience].
Harefuah. 2002 Nov; 141(11):953-6, 1011.H

Abstract

Portal hypertension in the absence of liver disease in children remains a therapeutic challenge. Despite successful control of variceal bleeding in most children, the risk of massive GI bleeding and mechanical disturbance of a huge spleen associated with hypersplenism exists throughout life. Surgical shunt between the portal and systemic venous systems is considered a definitive solution for that problem.

AIMS

We present our experience with the porto-systemic shunt for extrahepatic portal hypertension.

PATIENTS AND METHODS

Nine children (mean age 11.4 years) with portal hypertension were referred for a shunt procedure during a 5-year period (1996-2001). We reviewed patients charts for clinical parameters before and after surgery as well as surgical data (type of shunt, portal pressure gradient). A mesocaval shunt was constructed in 5 children, a splenorenal shunt in 3 other children and one child with splenic vein thrombosis underwent splenectomy alone for presumed diagnosis of left sided portal hypertension.

RESULTS

During a mean follow-up period of 21.2 months (range 6-63 months), the surgical shunt remained patent in 7 of the 8 children. An immediate drop in portal pressure and increased platelets count over time was noted in those 7 children. In two children high portal pressure persisted after surgery, including a child who underwent mesocaval shunt following a previous failed splenorenal shunt and another child who underwent splenectomy alone. None of the children bled following the shunt procedure and decreased splenic size was observed in the 3 children with massive splenomegaly.

CONCLUSIONS

We suggest that the porto-systemic shunt is indicated for children with non-hepatic portal hypertension suffering with uncontrolled bleeding and those with massive splenomegaly associated with hypersplenism.

Authors+Show Affiliations

Department of Transplantation, Schneider Children's Medical Center, Petah Tikva.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

heb

PubMed ID

12476627

Citation

Mor, Eytan, et al. "[Porto-systemic Shunts in Children: Schneider Children's Medical Center Experience]." Harefuah, vol. 141, no. 11, 2002, pp. 953-6, 1011.
Mor E, Bar-Nathan N, Shapira R, et al. [Porto-systemic shunts in children: Schneider Children's Medical Center experience]. Harefuah. 2002;141(11):953-6, 1011.
Mor, E., Bar-Nathan, N., Shapira, R., Katchko, M., & Dinari, G. (2002). [Porto-systemic shunts in children: Schneider Children's Medical Center experience]. Harefuah, 141(11), 953-6, 1011.
Mor E, et al. [Porto-systemic Shunts in Children: Schneider Children's Medical Center Experience]. Harefuah. 2002;141(11):953-6, 1011. PubMed PMID: 12476627.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Porto-systemic shunts in children: Schneider Children's Medical Center experience]. AU - Mor,Eytan, AU - Bar-Nathan,Nati, AU - Shapira,Riki, AU - Katchko,Mila, AU - Dinari,Gabriel, PY - 2002/12/13/pubmed PY - 2003/1/1/medline PY - 2002/12/13/entrez SP - 953-6, 1011 JF - Harefuah JO - Harefuah VL - 141 IS - 11 N2 - UNLABELLED: Portal hypertension in the absence of liver disease in children remains a therapeutic challenge. Despite successful control of variceal bleeding in most children, the risk of massive GI bleeding and mechanical disturbance of a huge spleen associated with hypersplenism exists throughout life. Surgical shunt between the portal and systemic venous systems is considered a definitive solution for that problem. AIMS: We present our experience with the porto-systemic shunt for extrahepatic portal hypertension. PATIENTS AND METHODS: Nine children (mean age 11.4 years) with portal hypertension were referred for a shunt procedure during a 5-year period (1996-2001). We reviewed patients charts for clinical parameters before and after surgery as well as surgical data (type of shunt, portal pressure gradient). A mesocaval shunt was constructed in 5 children, a splenorenal shunt in 3 other children and one child with splenic vein thrombosis underwent splenectomy alone for presumed diagnosis of left sided portal hypertension. RESULTS: During a mean follow-up period of 21.2 months (range 6-63 months), the surgical shunt remained patent in 7 of the 8 children. An immediate drop in portal pressure and increased platelets count over time was noted in those 7 children. In two children high portal pressure persisted after surgery, including a child who underwent mesocaval shunt following a previous failed splenorenal shunt and another child who underwent splenectomy alone. None of the children bled following the shunt procedure and decreased splenic size was observed in the 3 children with massive splenomegaly. CONCLUSIONS: We suggest that the porto-systemic shunt is indicated for children with non-hepatic portal hypertension suffering with uncontrolled bleeding and those with massive splenomegaly associated with hypersplenism. SN - 0017-7768 UR - https://www.unboundmedicine.com/medline/citation/12476627/[Porto_systemic_shunts_in_children:_Schneider_Children's_Medical_Center_experience]_ DB - PRIME DP - Unbound Medicine ER -