Clinical

Portosystemic shunts can safely treat portal hypertension in children

Last Updated: 2004-08-23 14:58:06 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Findings from a new study suggest that portosystemic shunts (PSS), especially the distal splenorenal shunt, are a safe and effective therapy for portal hypertension in children.

The results are based on a study of 20 children who underwent shunting at the University of Nebraska Medical Center in Omaha between 1987 and 2002, according to the report in the Journal of the American College of Surgeons for August.

In all cases, the indication for PSS was variceal bleeding despite endoscopic therapy. The causes of portal hypertension included portal vein thrombosis in 13 children, biliary atresia in 3, congenital hepatic fibrosis in 2, hepatitis C cirrhosis in 1 and Budd-Chiari syndrome in 1 patient. With the exception of two patients who were Child-Turcotte-Pugh class B, all of the subjects were class A at the time of shunting.

Seventeen children received a distal splenorenal shunt and three received a mesocaval venous interposition shunt, lead author Dr. Jean F. Botha and colleagues note. None of the patients died within 30 days of surgery.

At a median follow-up period of 31 months, 19 patients were alive with no evidence of further gastrointestinal bleeding. One patient underwent liver transplantation 2 years after shunting and one patient died of liver failure while on the transplantation waiting list.

In terms of long-term sequelae, two patients experienced worsening ascites, one patient experienced two episodes of hematemesis, one patient had mild encephalopathy, and one patient required angioplasty for shunt stenosis.

The findings suggest that PSS is a useful therapy for many children with portal hypertension, the authors state. "Liver transplantation should be reserved for children with poor synthetic function associated with variceal bleeding," they add.

J Am Coll Surg 2004;199:179-185.