Document Detail

Extrahepatic portal hypertension in children: observations on three surgical procedures.
MedLine Citation:
PMID:  15351894     Owner:  NLM     Status:  MEDLINE    
This paper presents a comparative prospective study of three modalities of surgical treatment for extrahepatic portal hypertension in children: central splenorenal shunt after splenectomy (CSS), side-to-side lienorenal shunt (SSLR) without splenectomy, and splenectomy and gastroesophageal devascularization (SGD). In an 18-month period, 27 procedures were performed: 10 CSS, 10 SSLR, and seven SGD. The outcomes were evaluated by fall in portal pressures, hematological parameters, shunt patency, splenic regression, and disappearance of esophageal varices. All three procedures were comparable in the fall of portal pressure after surgery. The average blood loss and operating time were statistically significant in favor of SSLR compared with CSS. At 3-month follow-up, shunt patency was confirmed by duplex Doppler study in all the patients in the SSLR group and in nine out of 10 patients in the CSS group. In the CSS and SGD groups, hypersplenism resolved in all the patients. In the SSLR group, blood counts improved in only five out of eight affected children. No patient re-bled during a follow-up of 3-5 years. There were no cases of hepatic encephalopathy or overwhelming postsplenectomy sepsis. In conclusion, CSS is useful when there is a large spleen, severe hypersplenism, and a shuntable splenic vein. SSLR is suitable when there is only mild splenomegaly, mild hypersplenism, and a shuntable splenic vein. Splenectomy and devascularization is the choice when there is no shuntable splenic vein.
K L N Rao; Anju Goyal; Prema Menon; B R Thapa; K L Narasimhan; S K Chowdhary; R Samujh; J K Mahajan
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2004-09-04
Journal Detail:
Title:  Pediatric surgery international     Volume:  20     ISSN:  0179-0358     ISO Abbreviation:  Pediatr. Surg. Int.     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-11-01     Completed Date:  2005-02-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8609169     Medline TA:  Pediatr Surg Int     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  679-84     Citation Subset:  IM    
Department of Pediatric Surgery, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, 160 012 Chandigarh, India.
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MeSH Terms
Hypersplenism / etiology
Hypertension, Portal / prevention & control,  surgery*
Prospective Studies
Splenorenal Shunt, Surgical
Treatment Outcome

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