The usefulness of distal splenorenal shunt in children with portal hypertension for the treatment of severe thrombocytopenia and leukopenia.
BACKGROUND
In the current era of transplantation and therapeutic endoscopy, the role of the distal splenorenal shunt (DSRS) for portal hypertension (PH) has diminished. We reviewed the outcome of the use of DSRS in children to determine the usefulness of this operation.


METHODS
In the follow-up course for PH from 1987 to 2006, 15 patients who developed severe thrombocytopenia (platelet count <50 x 10(3)/mm(3)) and/or leukopenia (WBC count <3000/mm(3)) with normal liver function were referred for DSRS. Primary diagnosis was portal vein thrombosis (N=10) and congenital hepatic fibrosis (N=5). Platelet, WBC count, liver function test, and spleen size were checked before and after DSRS. Shunt patency was accessed postoperatively. Operative morbidity, mortality, and long-term outcomes were measured.


RESULTS
Platelet count and WBC count increased in individual patients. Mean value of each count increased significantly after DSRS (p=0.002, .004, respectively). Spleen size decreased significantly (N=7, p=0.018). Shunt patency rate was 100%. There was one postoperative complication and no postoperative mortality. Two patients developed portopulmonary hypertension. No patients underwent subsequent transplantation or endoscopic treatment for gastroesophageal varices after DSRS.


CONCLUSIONS
DSRS is an effective and reliable procedure for children with PH and is still useful for selected pediatric patients.
Moon
Suk-Bae
SB
Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea. medica95@medimail.co.kr
Jung
Sung-Eun
SE
Ha
Jong-Won
JW
Park
Kwi-Won
KW
Seo
Jeong-Kee
JK
Kim
Woo-Ki
WK
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D007958:Leukocyte Count / Q000706:statistics & numerical data; D007970:Leukopenia / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D010976:Platelet Count / Q000706:statistics & numerical data; D013164:Splenorenal Shunt, Surgical / Q000379:methods*; D018709:Statistics, Nonparametric; D013921:Thrombocytopenia / Q000601:surgery*; D016896:Treatment Outcome