title: Direct bypassing of extrahepatic portal venous obstruction in children: a new technique for combined hepatic portal revascularization and treatment of extrahepatic portal hypertension.
abstract: BACKGROUND
  Decompression of extrahepatic portal hypertension by directly bypassing the thrombosed portal vein has never been reported in cases of children with idiopathic (or neonatal) portal vein obstruction and cavernoma.
  
  
  METHODS
  Seven children (15 years or younger) with portal vein obstruction requiring surgical decompression (urgently in two cases), and in whom preoperative Doppler had shown that the intrahepatic portal branches were hypoplastic but free of thrombus, were included in a pilot study. The cavernoma was bypassed by interposing a venous jugular autograft between the superior mesenteric vein and the distal portion of the left portal vein. Patients received follow-up using routine clinical parameters, upper gastrointestinal endoscopy, and Doppler ultrasound.
  
  
  RESULTS
  The mesenterico-portal bypass restored a direct (physiological) hepatopetal portal flow. The operation resulted in effective portal decompression as demonstrated by decrease of the pressure gradient, rapid regression of clinical signs of portal hypertension, and definitive control of bleeding.
  
  
  CONCLUSIONS
  This study shows that direct bypassing of portal cavernoma is possible and results in effective portal decompression. Restoration of the hepatic portal flow is a major advantage compared with conventional surgical shunting procedures. This new technique is potentially applicable to two thirds of children with portal vein thrombosis and should be considered when shunting procedures are indicated.
authors.affiliation: St Luc University Clinics, Louvain Medical School in Brussels, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: de Ville de Goyet
authors.forename: D
authors.initials: D
authors.lastname: Alberti
authors.forename: P
authors.initials: P
authors.lastname: Clapuyt
authors.forename: D
authors.initials: D
authors.lastname: Falchetti
authors.forename: V
authors.initials: V
authors.lastname: Rigamonti
authors.forename: N M
authors.initials: NM
authors.lastname: Bax
authors.forename: J B
authors.initials: JB
authors.lastname: Otte
authors.forename: E M
authors.initials: EM
authors.lastname: Sokal
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D007223:Infant; D007601:Jugular Veins / Q000637:transplantation*; D008642:Mesenteric Veins / Q000601:surgery; D010865:Pilot Projects; D011169:Portal Vein / Q000601:surgery; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D013927:Thrombosis / Q000150:complications / Q000601:surgery*; D014182:Transplantation, Autologous