title: Mesenterico-left intrahepatic portal vein shunt: original technique to treat symptomatic extrahepatic portal hypertension.
abstract: MESENTERICO-LEFT INTRAHEPATIC PORTAL VEIN SHUNT: Original technique to treat symptomatic extrahepatic portal hypertension.
  
  
  OBJECTIVE
  Revascularization of the intrahepatic portal system as decompressive surgery for chronic extrahepatic portal hypertension.
  
  
  BACKGROUND
  In patients with extrahepatic portal hypertension (portal trunk thrombosis in presence of a normal liver), shunt surgery is indicated when patient is bleeding from varices at a site not accessible for the endoscopist. Although surgical portal decompression is an efficient procedure, there is a risk of depriving the liver from the splanchnic venous flow and a risk of developing porto-systemic shunt related side effects.
  
  
  METHODS
  A shunt was created between the superior mesenteric vein and the umbilical portion of the left portal vein. This technique allows to bypass the thrombosed portion of the portal vein but avoiding dissection of the cavernoma in the liver hilum and related risk of intraoperative hemorrhage.
  
  
  RESULTS
  The procedure was successfully performed in one adult patient considered unshuntable in view of classic surgical procedures and in whom sclerotherapy was unsuccessful. This operation achieved an effective decompression of the splanchnic venous system.
  
  
  CONCLUSIONS
  Rerouting the venous splanchnic flow through the liver was possible. It had the major physiological advantage of restoring the normal hepatic vascularization. It also avoided putting the patient at risk of developing porto-systemic shunt related side effects. This option should be considered when shunt procedures are indicated in patients with extrahepatic portal hypertension.
authors.affiliation: Departments of Pediatric Surgery, Cliniques Universitaires St Luc, Catholic University of Louvain, Brussels, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: de Ville de Goyet
authors.forename: J P
authors.initials: JP
authors.lastname: Martinet
authors.forename: M
authors.initials: M
authors.lastname: Lacrosse
authors.forename: P
authors.initials: P
authors.lastname: Goffette
authors.forename: M
authors.initials: M
authors.lastname: Melange
authors.forename: J
authors.initials: J
authors.lastname: Lerut
mesh_terms: D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D011169:Portal Vein / Q000601:surgery; D013927:Thrombosis / Q000601:surgery*