Mesoportal bypass for extrahepatic portal vein obstruction in children: close to a cure for most!

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.

journal_name

J Pediatr Surg

authors

Sharif K,McKiernan P,de Ville de Goyet J

doi

10.1016/j.jpedsurg.2009.08.019

subject

Has Abstract

pub_date

2010-01-01 00:00:00

pages

272-6

issue

1

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(09)00698-8

journal_volume

45

pub_type

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