[The choice of an operation for correction of portal hypertension in children  (author's transl)].
The choice of a surgical procedure for correction of portal hypertension in children should be guided by the site of the blockage on portal circulation, its anatomic and hemodynamic conditions, and also by the experience of the surgical team. At the present time, in our series, distal splenorenal shunt, or meso caval shunt with jugular vein interposition are preferred to the more usual ones, such as the central splenorenal shunt with splenectomy or mesocaval shunt with iliac vein. Thus an extrahepatic block would be treated by an interposition shunt, or a distal splenorenal shunt if the splenic vein is of a proper diameter; an intrahepatic block would be treated by a Warren shunt, even though some of the latest publications on the subject underline the fact that the disconnection part of the operation does not last with time; in the case of a suprahepatic block, a mesocaval shunt with interposition could be constructed provided the pressure in the lower vena cava is not too elevated; the same operation could be planed for difficult situations such as failures of a previous shunt or extensive thrombosis of the portal vein and tributaries. As for direct action on esophageal varices, every one agrees about the poor quality of results in the case of simple ligation; however the experience with more extensive operations such as Sugiura's procedure, and also that of endoscopic sclerosis or embolization in children are yet short and limited.
D002648:Child; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology / Q000601:surgery*; D011168:Portal System / Q000503:physiopathology; D013164:Splenorenal Shunt, Surgical
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