Paediatric Hepatobiliary Supplement

Surgery for portal hypertension in children: A 12-year review

N Patel, A Grieve, J Hiddema, J Botha, J Loveland

Abstract


Background. Portal hypertension is a common and potentially devastating condition in children. Notwithstanding advances in the nonsurgical management of portal hypertension, surgery remains an important treatment modality in select patients. We report here on our experience in the past 12 years.

Objectives. To describe the profile of, indication for, and complications of shunt surgery in children with portal hypertension.

Methods. Twelve children underwent shunt surgery between 2005 and 2017. Patient records were reviewed.

Results. Fourteen procedures were performed on 12 patients during the study period. The median age at surgery was 6.5 (range 1 - 18) years. Six patients were male. Gastrointestinal bleeding that was not amenable to endoscopic control was the most common indication for surgery. Portal vein thrombosis was the most common cause of portal hypertension in our series (n=11). Two-thirds (8/12) of all patients had an identifiable underlying risk factor for portal vein thrombosis. One-third of all patients (4/12) underwent a meso-portal bypass procedure (Rex shunt), while 58% (7/12) were managed with a distal splenorenal shunt. All patients received postoperative thromboprophylaxis. We experienced a single mortality, 1 patient experienced shunt thrombosis that required revision shunt surgery, and 2 patients experienced anastomotic strictures, with one being managed with revision surgery and the other currently awaiting radiological venoplasty.

Conclusions. Surgery is a safe and important tool in the management of children with non-cirrhotic portal hypertension and those with sufficient hepatic reserve who fail to respond to more conservative methods for the treatment of side effects of portal hypertension.


Authors' affiliations

N Patel, Department of Paediatric Surgery, University of the Witwatersrand, Johannesburg, South Africa

A Grieve, Department of Paediatric Surgery, University of the Witwatersrand, Johannesburg, South Africa

J Hiddema, Department of Paediatric Surgery, University of the Witwatersrand, Johannesburg, South Africa

J Botha, Division of Transplant Surgery, Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa

J Loveland, Department of Paediatric Surgery, University of the Witwatersrand, Johannesburg, South Africa

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Cite this article

South African Medical Journal 2017;107(10):S12-S15.

Article History

Date submitted: 2017-11-06
Date published: 2017-11-06

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