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Mesoportal bypass for extrahepatic portal vein obstruction in children: close to a cure for most!
J Pediatr Surg. 2010 Jan; 45(1):272-6.JP

Abstract

AIM

Extrahepatic portal vein obstruction (EPVO) is a common cause of portal hypertension in children and can lead to life-threatening bleeding, thrombocytopenia, and coagulation disorders. Mesoportal bypass (MPB) restores normal physiologic portal flow to the liver and corrects portal hypertension. There is, however, little long-term outcome data after MPB. The aim of our study was to analyze the long-term outcome after MPB in children.

METHODS

Retrospective single-center review of all MPB with more than 5-year follow-up was performed in children between 1998 and 2003.

RESULTS

Thirty children underwent MPB, which was successful in 29. Long-term follow-up is available for 24. Median age at the time of bypass was 8.5 years (range, 0.4-14.2 years). Material used for bypass was as follows: left internal jugular vein (n = 20), recanalized umbilical vein (n = 2), gastric vein, and a large colic vein (n = 2). Median time since MPB is 8 years (range, 5.3-8.8 years). One MPB using recanalized umbilical vein thrombosed at 4 months but was successfully refashioned using Gortex. One MPB with left internal jugular vein was thrombosed at 1 year after cardiac surgery. Overall, 23 of 24 children have a patent bypass and resolution of portal hypertension. All showed an decrease in spleen size. Recurrent blood flow in the cavernoma with secondary increase in spleen size occurred in 5 children (median time, 3.4 years after MPB). Further evaluation of these 5 revealed no recurrence of portal hypertension.

CONCLUSION

The MPB provides long-term correction of portal hypertension owing to EPVO. Where technically feasible, MPB is the preferred surgical procedure for treatment of EPVO.

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Authors+Show Affiliations

Sharif K
Liver Unit, Birmingham Children's Hospital, B4 6NH Birmingham, UK. khalid.sharif@bch.nhs.uk
McKiernan P
No affiliation info available
de Ville de Goyet J
No affiliation info available

MeSH

AdolescentChildChild, PreschoolFemaleFollow-Up StudiesHumansHypertension, PortalInfantJugular VeinsLiver CirculationLongitudinal StudiesMaleMesenteric VeinsPortal VeinPortasystemic Shunt, SurgicalPostoperative ComplicationsRecurrenceThrombosisTransplantation, AutologousTreatment OutcomeUmbilical VeinsVascular PatencyVenous Thrombosis

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20105620

Citation

Sharif, Khalid, et al. "Mesoportal Bypass for Extrahepatic Portal Vein Obstruction in Children: Close to a Cure for Most!" Journal of Pediatric Surgery, vol. 45, no. 1, 2010, pp. 272-6.
Sharif K, McKiernan P, de Ville de Goyet J. Mesoportal bypass for extrahepatic portal vein obstruction in children: close to a cure for most! J Pediatr Surg. 2010;45(1):272-6.
Sharif, K., McKiernan, P., & de Ville de Goyet, J. (2010). Mesoportal bypass for extrahepatic portal vein obstruction in children: close to a cure for most! Journal of Pediatric Surgery, 45(1), 272-6. https://doi.org/10.1016/j.jpedsurg.2009.08.019
Sharif K, McKiernan P, de Ville de Goyet J. Mesoportal Bypass for Extrahepatic Portal Vein Obstruction in Children: Close to a Cure for Most. J Pediatr Surg. 2010;45(1):272-6. PubMed PMID: 20105620.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mesoportal bypass for extrahepatic portal vein obstruction in children: close to a cure for most! AU - Sharif,Khalid, AU - McKiernan,Patrick, AU - de Ville de Goyet,Jean, PY - 2009/06/05/received PY - 2009/08/01/revised PY - 2009/08/03/accepted PY - 2010/1/29/entrez PY - 2010/1/29/pubmed PY - 2010/3/13/medline SP - 272 EP - 6 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 45 IS - 1 N2 - AIM: Extrahepatic portal vein obstruction (EPVO) is a common cause of portal hypertension in children and can lead to life-threatening bleeding, thrombocytopenia, and coagulation disorders. Mesoportal bypass (MPB) restores normal physiologic portal flow to the liver and corrects portal hypertension. There is, however, little long-term outcome data after MPB. The aim of our study was to analyze the long-term outcome after MPB in children. METHODS: Retrospective single-center review of all MPB with more than 5-year follow-up was performed in children between 1998 and 2003. RESULTS: Thirty children underwent MPB, which was successful in 29. Long-term follow-up is available for 24. Median age at the time of bypass was 8.5 years (range, 0.4-14.2 years). Material used for bypass was as follows: left internal jugular vein (n = 20), recanalized umbilical vein (n = 2), gastric vein, and a large colic vein (n = 2). Median time since MPB is 8 years (range, 5.3-8.8 years). One MPB using recanalized umbilical vein thrombosed at 4 months but was successfully refashioned using Gortex. One MPB with left internal jugular vein was thrombosed at 1 year after cardiac surgery. Overall, 23 of 24 children have a patent bypass and resolution of portal hypertension. All showed an decrease in spleen size. Recurrent blood flow in the cavernoma with secondary increase in spleen size occurred in 5 children (median time, 3.4 years after MPB). Further evaluation of these 5 revealed no recurrence of portal hypertension. CONCLUSION: The MPB provides long-term correction of portal hypertension owing to EPVO. Where technically feasible, MPB is the preferred surgical procedure for treatment of EPVO. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/20105620/Mesoportal_bypass_for_extrahepatic_portal_vein_obstruction_in_children:_close_to_a_cure_for_most L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(09)00698-8 DB - PRIME DP - Unbound Medicine ER -