title: Portal hypertension: A critical appraisal of shunt procedures with emphasis on distal splenorenal shunt in children.
abstract: BACKGROUND
  Extrahepatic portal venous obstruction (EHPVO) is the most common cause of pediatric portal hypertension. We analyzed the investigative protocol and results of portosystemic shunts in this group of patients.
  
  
  METHODS
  A total of 40 consecutive children aged below 12 years operated with a diagnosis of extra-hepatic portal hypertension formed the study group. Historical data and clinical data were collected. All patients underwent upper gastrointestinal endoscopy, ultrasound Doppler and computed tomographic portogram pre-operatively and post-operatively. Results with respect to shunt patency, hypersplenism and efficacy of different radiological investigations were collected.
  
  
  RESULTS
  A total of 40 patients, 28 boys and 12 girls constituted the study group. Lienorenal shunt (LRS) was performed in 14 patients; distal splenorenal shunt in 21 patients and side-to-side lienorenal shunt in 4 patients, inferior mesenteric renal shunt was performed in 1 patient. Follow-up ranged from 36 to 70 months. At a minimum follow-up of 3 years, 32 (80%) patients were found to have patent shunts. Patent shunts could be visualized in 30/32 patients with computer tomographic portogram (CTP) and 28/32 with ultrasound. Varices regressed completely in 26/32 patients and in the rest incomplete regression was seen. Spleen completely regressed in 19/25 patients. Hypersplenism resolved in all patients with patent shunts.
  
  
  CONCLUSIONS
  Portosystemic shunting in children with EHPVO is a viable option. While long-term cure rates are comparable with sclerotherapy, repeated hospital visits are reduced with one time surgery. Pre-operative and post-operative assessment can be performed with complimentary use of ultrasound, CTP and endoscopy.
authors.affiliation: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Nitin
authors.initials: N
authors.lastname: Sharma
authors.affiliation: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Minu
authors.initials: M
authors.lastname: Bajpai
authors.affiliation: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Arbinder
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Shashi
authors.initials: S
authors.lastname: Paul
authors.affiliation: Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Manisha
authors.initials: M
authors.lastname: Jana
keywords: Computer tomographic portogram; distal spleno-renal shunt; endoscopic sclerotherapy; extra-hepatic portal hypertension; extra-hepatic portal venous obstruction; hypersplenism; lieno-renal shunt
references.citation: World J Surg. 1994 Mar-Apr;18(2):251-8
references.pmid: 8042331
references.citation: Clin Imaging. 1999 Nov-Dec;23(6):377-85
references.pmid: 10899422
references.citation: Br J Surg. 1988 May;75(5):404-8
references.pmid: 3390666
references.citation: World J Surg. 2005 Aug;29(8):1034-6; discussion 1037
references.pmid: 15977080
references.citation: J Pediatr Gastroenterol Nutr. 2003 Nov;37(5):538-45
references.pmid: 14581793
references.citation: J Pediatr Surg. 1994 Feb;29(2):142-51; discussion 151-4
references.pmid: 8176584
references.citation: J Gastroenterol Hepatol. 2002 Jan;17(1):6-16
references.pmid: 11895549
references.citation: J Pediatr Surg. 1978 Feb;13(1):51-7
references.pmid: 305475
references.citation: Rozhl Chir. 2001 May;80(5):246-9
references.pmid: 11392047
references.citation: Ann Surg. 1977 Feb;185(2):224-8
references.pmid: 300005
references.citation: J Gastrointest Surg. 1999 Mar-Apr;3(2):167-72
references.pmid: 10457341
references.citation: World J Surg. 2008 Mar;32(3):483-7
references.pmid: 18196322
references.citation: Ann Surg. 1980 Jul;192(1):18-24
references.pmid: 7406558
references.citation: J Gastroenterol Hepatol. 2004 Feb;19(2):139-45
references.pmid: 14731122
references.citation: Jpn J Surg. 1980 Mar;10(1):84-7
references.pmid: 7373958
references.citation: Clin Imaging. 2000 Nov-Dec;24(6):351-6
references.pmid: 11368936
references.citation: J Pediatr Gastroenterol Nutr. 1986 Nov-Dec;5(6):861-6
references.pmid: 3794903