title: Portosystemic shunting in children during the era of endoscopic therapy: improved postoperative growth parameters.
abstract: BACKGROUND
  Surgical portosystemic shunting has been performed less frequently in recent years. In this retrospective study, recent outcomes of portosystemic shunting in children are described, to evaluate its role in the era of endoscopic therapy.
  
  
  METHODS
  Retrospective chart review of children who underwent surgical portosystemic shunt procedures between October 1994 and October 1997.
  
  
  RESULTS
  Twelve children (age range, 1-16 years) underwent shunting procedures. The causes of portal hypertension were extrahepatic portal vein thrombosis (n = 6), congenital hepatic fibrosis (n = 2), hepatic cirrhosis (n = 2), and other (n = 2). None of the patients were immediate candidates for liver transplantation. Types of shunt included: distal splenorenal (n = 10), portocaval (n = 1), and other (n = 1). Median follow-up was 35 months (range, 24-48 months). All patients are currently alive and well with patent shunts. The mean hospital stay was 8 days. Three patients required readmission for further interventions because of shunt stenosis in two and small bowel obstruction in the other. Mild portosystemic encephalopathy was seen in one child with pre-existing neurobehavioral disturbance. Excluding a patient who underwent placement of a portosystemic shunt for a complication of liver transplantation, mean weight-for-age z score in nine prepubertal patients improved from -1.16 SD to +0.15 SD (P = 0.023), and mean height-for-age z score from -1.23 SD to 0.00 SD (P = 0.048) by 2 years after surgery.
  
  
  CONCLUSIONS
  Surgical portosystemic shunting is a safe and effective method for the management of portal hypertension in childhood. Patients show significant improvements in growth parameters after the procedure. Surgical portosystemic shunting should be actively considered in selected children with portal hypertension.
authors.affiliation: Division of Transplantation, University of Miami, School of Medicine, Florida 33136, USA.
authors.forename: T
authors.initials: T
authors.lastname: Kato
authors.forename: R
authors.initials: R
authors.lastname: Romero
authors.forename: R
authors.initials: R
authors.lastname: Koutouby
authors.forename: N K
authors.initials: NK
authors.lastname: Mittal
authors.forename: J F
authors.initials: JF
authors.lastname: Thompson
authors.forename: C L
authors.initials: CL
authors.lastname: Schleien
authors.forename: A G
authors.initials: AG
authors.lastname: Tzakis
mesh_terms: D000293:Adolescent; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control; D006128:Growth; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D007223:Infant; D007902:Length of Stay; D008297:Male; D008499:Medical Records; D011170:Portasystemic Shunt, Surgical; D012189:Retrospective Studies; D016896:Treatment Outcome