title: [Porto-systemic shunts in children: Schneider Children's Medical Center experience].
abstract: Portal hypertension in the absence of liver disease in children remains a therapeutic challenge. Despite successful control of variceal bleeding in most children, the risk of massive GI bleeding and mechanical disturbance of a huge spleen associated with hypersplenism exists throughout life. Surgical shunt between the portal and systemic venous systems is considered a definitive solution for that problem.
  
  
  OBJECTIVE
  We present our experience with the porto-systemic shunt for extrahepatic portal hypertension.
  
  
  METHODS
  Nine children (mean age 11.4 years) with portal hypertension were referred for a shunt procedure during a 5-year period (1996-2001). We reviewed patients charts for clinical parameters before and after surgery as well as surgical data (type of shunt, portal pressure gradient). A mesocaval shunt was constructed in 5 children, a splenorenal shunt in 3 other children and one child with splenic vein thrombosis underwent splenectomy alone for presumed diagnosis of left sided portal hypertension.
  
  
  RESULTS
  During a mean follow-up period of 21.2 months (range 6-63 months), the surgical shunt remained patent in 7 of the 8 children. An immediate drop in portal pressure and increased platelets count over time was noted in those 7 children. In two children high portal pressure persisted after surgery, including a child who underwent mesocaval shunt following a previous failed splenorenal shunt and another child who underwent splenectomy alone. None of the children bled following the shunt procedure and decreased splenic size was observed in the 3 children with massive splenomegaly.
  
  
  CONCLUSIONS
  We suggest that the porto-systemic shunt is indicated for children with non-hepatic portal hypertension suffering with uncontrolled bleeding and those with massive splenomegaly associated with hypersplenism.
authors.affiliation: Department of Transplantation, Schneider Children's Medical Center, Petah Tikva.
authors.forename: Eytan
authors.initials: E
authors.lastname: Mor
authors.forename: Nati
authors.initials: N
authors.lastname: Bar-Nathan
authors.forename: Riki
authors.initials: R
authors.lastname: Shapira
authors.forename: Mila
authors.initials: M
authors.lastname: Katchko
authors.forename: Gabriel
authors.initials: G
authors.lastname: Dinari
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D007223:Infant; D008297:Male; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors