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Portosystemic shunts in children: a 15-year experience.
J Am Coll Surg. 2004 Aug; 199(2):179-85.JA

Abstract

BACKGROUND

The role of portosystemic shunt (PSS) in children with portal hypertension has changed because of acceptance of liver transplantation and endoscopic hemostasis. We report our experience with PSS, mainly the distal splenorenal shunt, to define its role in the management of variceal bleeding.

STUDY DESIGN

From 1987 to 2002, 20 children with variceal bleeding after endoscopic therapy underwent PSS. Patient and database records were reviewed.

RESULTS

There were 14 boys and 6 girls; mean age was 11 years (range 3 to 18 years). Seventeen distal splenorenal and three mesocaval venous interposition shunts were performed. There was no operative mortality, 19 patients were alive at a median followup of 31 months (range 4 to 168 months) without evidence of recurrent gastrointestinal bleeding. One patient underwent transplantation 2 years after PSS and 1 patient died of hepatic failure while awaiting transplantation. The cause of portal hypertension was portal vein thrombosis (n = 13), biliary atresia (n = 3), congenital hepatic fibrosis (n = 2), hepatitis C cirrhosis (n = 1), and Budd-Chiari syndrome (n = 1). Eighteen children were Child-Turcotte-Pugh class A and the remaining two were class B. One patient had two episodes of hematemesis after PSS. Two patients had worsening ascites. One patient had mild encephalopathy and one patient had shunt stenosis requiring angioplasty.

CONCLUSIONS

PSS is a safe and durable therapy for pediatric patients with portal hypertension. Liver transplantation should be reserved for children with poor synthetic function associated with variceal bleeding. PSS may also serve as a bridge to transplantation in patients with preserved hepatic function. PSS, in particular the distal splenorenal shunt, has produced excellent results. This experience challenges the need for alternative forms of portal decompression.

Authors+Show Affiliations

Division of Transplantation, Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198-3285, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15275870

Citation

Botha, Jean F., et al. "Portosystemic Shunts in Children: a 15-year Experience." Journal of the American College of Surgeons, vol. 199, no. 2, 2004, pp. 179-85.
Botha JF, Campos BD, Grant WJ, et al. Portosystemic shunts in children: a 15-year experience. J Am Coll Surg. 2004;199(2):179-85.
Botha, J. F., Campos, B. D., Grant, W. J., Horslen, S. P., Sudan, D. L., Shaw, B. W., & Langnas, A. N. (2004). Portosystemic shunts in children: a 15-year experience. Journal of the American College of Surgeons, 199(2), 179-85.
Botha JF, et al. Portosystemic Shunts in Children: a 15-year Experience. J Am Coll Surg. 2004;199(2):179-85. PubMed PMID: 15275870.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Portosystemic shunts in children: a 15-year experience. AU - Botha,Jean F, AU - Campos,B Daniel, AU - Grant,Wendy J, AU - Horslen,Simon P, AU - Sudan,Debra L, AU - Shaw,Byers W,Jr AU - Langnas,Alan N, PY - 2003/12/30/received PY - 2004/03/10/revised PY - 2004/03/17/accepted PY - 2004/7/28/pubmed PY - 2004/8/21/medline PY - 2004/7/28/entrez SP - 179 EP - 85 JF - Journal of the American College of Surgeons JO - J Am Coll Surg VL - 199 IS - 2 N2 - BACKGROUND: The role of portosystemic shunt (PSS) in children with portal hypertension has changed because of acceptance of liver transplantation and endoscopic hemostasis. We report our experience with PSS, mainly the distal splenorenal shunt, to define its role in the management of variceal bleeding. STUDY DESIGN: From 1987 to 2002, 20 children with variceal bleeding after endoscopic therapy underwent PSS. Patient and database records were reviewed. RESULTS: There were 14 boys and 6 girls; mean age was 11 years (range 3 to 18 years). Seventeen distal splenorenal and three mesocaval venous interposition shunts were performed. There was no operative mortality, 19 patients were alive at a median followup of 31 months (range 4 to 168 months) without evidence of recurrent gastrointestinal bleeding. One patient underwent transplantation 2 years after PSS and 1 patient died of hepatic failure while awaiting transplantation. The cause of portal hypertension was portal vein thrombosis (n = 13), biliary atresia (n = 3), congenital hepatic fibrosis (n = 2), hepatitis C cirrhosis (n = 1), and Budd-Chiari syndrome (n = 1). Eighteen children were Child-Turcotte-Pugh class A and the remaining two were class B. One patient had two episodes of hematemesis after PSS. Two patients had worsening ascites. One patient had mild encephalopathy and one patient had shunt stenosis requiring angioplasty. CONCLUSIONS: PSS is a safe and durable therapy for pediatric patients with portal hypertension. Liver transplantation should be reserved for children with poor synthetic function associated with variceal bleeding. PSS may also serve as a bridge to transplantation in patients with preserved hepatic function. PSS, in particular the distal splenorenal shunt, has produced excellent results. This experience challenges the need for alternative forms of portal decompression. SN - 1072-7515 UR - https://www.unboundmedicine.com/medline/citation/15275870/Portosystemic_shunts_in_children:_a_15_year_experience_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1072-7515(04)00395-3 DB - PRIME DP - Unbound Medicine ER -