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SURGERY FOR PORTAL HYPERTENSION IN
CHILDREN: A 12-YEAR REVIEW
Definition
Classification
Classification
Aetiology:
(i) Hepatocellular disease with liver fibrosis
(ii) Primary vascular abnormalities
Underlying pathophysiology:
(i) Resistance to flow
(ii) Increase flow
(iii) Both
Presentation
A: Ascites
B: Bleeding
C: Caput Medusae
D: Diminished Liver
E: Enlarged Spleen
Presentation
Surgical Indications
Uncontrolled bleeding from oesophageal varices
Bleeding gastric or ectopic varices
Hypersplenism or massive splenomegaly
Symptomatic biliopathy
Isolated EHPVO
Limited access to endoscopy
Patient choice
Types of surgery
Physiological vs non-physiological
Rex Shunt
Non-Selective Portosystemic Shunt (PSS)
(i) Total
(ii) Partial
Selective PSS
Risk of encephalopathy balanced against risk of
rebleeding
Types of surgery
Study aims
Demographic profile
Surgical indication
Surgical technique
Complications
Methods
Retrospective record review
12 year period (2005-2017)
Chris Hani Baragwanath Academic Hospital
Charlotte Maxeke Johannesburg Academic Hospital
Wits Donald Gordon Medical Centre
Sandton Mediclinic
Ethics approval (M170647)
Results
14 shunt procedures
12 children
6 male
Median age 6.5 years
Range 1 – 18 years
Results
Results
Results
Going Forward
Surgery remains relevant
(i) Cure
(ii) Bridge to transplantation
Choice of surgery
Collaboration with paediatric hepatologists
Follow up study in 5 – 10 years
Gaps in data collection
References
Botha JF, Campos BD, Grant WJ, et al. Portosystemic shunts in shildren: A 15-year experience.
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Superina RA, Alonso EM. Medical and surgical management of portal hypertension in children.
Curr Treat Options Gastroenterol 2006;9(5):432-443.
https://doi.org/10.1007/BF02738533
De Ville de Goyet J, D’Ambrosio G, Grimaldi C. Surgical management of portal hypertension
in children. Semin Paediatr Surg 2012;21(3):219-232.
https://doi.org/10.1053/j.sempedsurg.2012.05.005
Gugig R, Rosenthal P. Management of portal hypertension in children. World J Gastroenterol
2012;21(18):1176-1184. https://doi.org/10.3748/wjg.v18.i11.1176
Bambini DA, Superina R, Almond PS, Whitington PF, Alonso E. Experience with the Rex shunt
(mesenterico-left portal bypass) in children with extrahepatic portal hypertension. J Pediatr
Surg 2000;35(1):13-18. https://doi.org/10.1016/S0022-3468(00)80005-6
Scholz S, Sharif K. Surgery for portal hypertension in children. Curr Gastroenterol Rep
2011;13(3):279-285. https://doi.org/10.1007/s11894-011-0186-8
Di Francesco F, Grimaldi C, De Ville de Goyet J. Meso-Rex bypass – a procedure to cure
prehepatic portal hypertension: The insight and the inside. J Am Coll Surg 2014;218(2):e23-
e36. https://doi.org/10.1016/j.jamcollsurg.2013.10.024
Thanks
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