title: Gastroportal shunt for portal hypertension in children.
abstract: OBJECTIVE
  Extrahepatic portal venous obstruction is the most common cause of portal hypertension in children. The Rex shunt has been used successfully to treat patients with extrahepatic portal hypertension. In the conventional Rex shunt, the internal jugular vein is used as a venous graft. Inevitably, such a procedure requires neck exploration and sacrifice of internal jugular vein. The authors describe a novel adaptation of gastroportal shunt, successfully carried out in 8 children with extrahepatic portal hypertension.
  
  
  METHODS
  The mean age of the 8 patients (6 boys and 2 girls) was 66.6 months at the time of operation. All children had portal hypertension. Seven had a history of upper gastrointestinal bleeding, and 4 had splenomegaly and hypersplenism. Gastroportal shunt was performed in all patients. The left gastric vein was mobilized and anastomosed to left portal vein. In 1 patient, the left gastric vein was not of adequate length and required a venous graft (the inferior mesenteric vein). All patients were followed up for 3 to 20 months (median, 9 months).
  
  
  RESULTS
  The gastroportal shunt was successfully performed in all patients. The median operative time was 265 minutes (range, 205-360 minutes). Operative blood loss was 21 ± 7.4 mL, and the length of hospital stay varied from 9 to 19 days (median, 15 days). Intraoperative portal venous angiography demonstrated the patency of the shunt in all patients. Postoperatively, the complete blood count normalized, and the biochemistry tests were within reference range. Postoperative ultrasound confirmed shunt patency and satisfactory flow in the gastroportal shunt in each patient. The size of spleen decreased. There was no recurrence of variceal bleeding.
  
  
  CONCLUSIONS
  The gastroportal shunt is an effective treatment of extrahepatic portal hypertension.
authors.affiliation: Department of Pediatric Surgery, Capital institute of Pediatrics, Beijing 100020, China.
authors.forename: Jin-Shan
authors.initials: JS
authors.lastname: Zhang
authors.forename: Long
authors.initials: L
authors.lastname: Li
authors.forename: Shu-Li
authors.initials: SL
authors.lastname: Liu
authors.forename: Wei
authors.initials: W
authors.lastname: Cheng
authors.forename: Mei
authors.initials: M
authors.lastname: Diao
authors.forename: Wen-Ying
authors.initials: WY
authors.lastname: Hou
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.forename: Sheng-Li
authors.initials: SL
authors.lastname: Li
authors.forename: Yao
authors.initials: Y
authors.lastname: Liu
authors.forename: Hai-Bin
authors.initials: HB
authors.lastname: Wang
authors.forename: An-Xiao
authors.initials: AX
authors.lastname: Ming
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008297:Male; D011169:Portal Vein / Q000601:surgery*; D013270:Stomach / Q000601:surgery*