Portal hypertension in children: 27 years’ experience of surgical treatment

Abstract

Surgical procedures are known to be most effective in preventing variceal bleeding (VB) in children with portal hypertension (PH). The quality of life, possibility of the portosystemic encephalopathy, and the deterioration of liver function after shunt procedures in children with PH are the aim of our study. Methods. 718 children with PH were treated in our hospital since 1989. 639 (89%) had extrahepatic PH. 577 patients underwent portal systemic shunting (PSS). In 81 children Rex-shunts were performed. In 24 patients Sugiura operations were done. Endoscopies, Duplex scanning, biochemical tests and psyhoneurological evaluation were performed after a one-year period. 172 patients were evaluated in 5-18 years after surgery to determinate the long-time results. Results: Re-bleeding occurred in 21 (3,7%) children with PPS. In the long–term period portal perfusion (PP) after PSS decreased down in 84%. No patient developed portal-systemic encephalopathy. No signs of liver function deterioration were found. The re-bleeding rate after Rex-shunt was 5,5%. In patients with Rex-shunt, a normal PP was restored in the early postoperative period. The Sugiura procedure produced the highest rate of re-bleeding – 25%. In 12 patients, we combined the Sugiura procedure with planned endoscopic sclerotherapy in the postoperative period. This decreased re-bleeding to 8,3%. Conclusions. The PSS is an effective and method of preventing of VB and does not seriously degrade quality of life of the child. The Rex shunt effectively restores PP in the post-operative period. In cases when shunt surgery is not possible, the Sugiura procedure is the operation of choice with endoscopic sclerotherapy for remnant varices.