Successful preemptive surgical division of type 2-congenital extrahepatic portosystemic shunt in children.
OBJECTIVE
A congenital extrahepatic portosystemic shunt (CEPS) is a rare abnormality. The shunts are classified into 2 types. Of these, a type 2-shunt is a side-to-side one, which may be treated by a simple shunt division. The aim of this retrospective study was to clarify the effects of a surgical shunt division on 4 children with type 2-CEPS.


METHODS
Between June 2002 and June 2008, 4 children with type 2-CEPS underwent a surgical shunt division. Various clinical factors of each patient, including shunt types, shut ratios evaluated by portal scintigraphy using (123)I-iodoamphetamine, serum levels of ammonia and total bile acids before and after surgery were evaluated.


RESULTS
Two children had a conventional open surgery and the other two had a laparoscopic surgery. The serum levels of ammonia as well as total bile acids of these children decreased significantly to the normal levels within a month after the surgical shunt divisions. All the children had a better clinical course.


CONCLUSIONS
A shunt division, especially by laparoscopic surgery, is an effective therapy for type 2-CEPS. To the best of our knowledge by reviewing literatures, our cases are the youngest ones treated by laparoscopic shunt division.
Nii
Akira
A
Department of Pediatric Surgery and Pediatric Endoscopic Surgery, Tokushima University Hospital, Japan.
Takehara
Hiro-o
HO
Kuyama
Hisako
H
Shimada
Mitsuo
M
D000641:Ammonia / Q000097:blood; D001647:Bile Acids and Salts / Q000097:blood; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods; D008297:Male; D011169:Portal Vein / Q000002:abnormalities* / Q000601:surgery*; D012082:Renal Veins / Q000002:abnormalities* / Q000601:surgery*; D012189:Retrospective Studies; D013162:Splenic Vein / Q000002:abnormalities* / Q000601:surgery*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
D001647:Bile Acids and Salts; D000641:Ammonia