Portosystemic shunts in children: A 15-year experience

Jean F. Botha, B. Daniel Campos, Wendy J. Grant, Simon P. Horslen, Debra L. Sudan, Byers W. Shaw, Alan Norman Langnas

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Background The role of portosystemic shunt (PSS) in children with portal hypertension has changed because of acceptance of liver transplantation and endoscopic hemostasis. We report our experience with PSS, mainly the distal splenorenal shunt, to define its role in the management of variceal bleeding. Study design From 1987 to 2002, 20 children with variceal bleeding after endoscopic therapy underwent PSS. Patient and database records were reviewed. Results There were 14 boys and 6 girls; mean age was 11 years (range 3 to 18 years). Seventeen distal splenorenal and three mesocaval venous interposition shunts were performed. There was no operative mortality, 19 patients were alive at a median followup of 31 months (range 4 to 168 months) without evidence of recurrent gastrointestinal bleeding. One patient underwent transplantation 2 years after PSS and 1 patient died of hepatic failure while awaiting transplantation. The cause of portal hypertension was portal vein thrombosis (n = 13), biliary atresia (n = 3), congenital hepatic fibrosis (n = 2), hepatitis C cirrhosis (n = 1), and Budd-Chiari syndrome (n = 1). Eighteen children were Child-Turcotte-Pugh class A and the remaining two were class B. One patient had two episodes of hematemesis after PSS. Two patients had worsening ascites. One patient had mild encephalopathy and one patient had shunt stenosis requiring angioplasty. Conclusions PSS is a safe and durable therapy for pediatric patients with portal hypertension. Liver transplantation should be reserved for children with poor synthetic function associated with variceal bleeding. PSS may also serve as a bridge to transplantation in patients with preserved hepatic function. PSS, in particular the distal splenorenal shunt, has produced excellent results. This experience challenges the need for alternative forms of portal decompression.

Original languageEnglish (US)
Pages (from-to)179-185
Number of pages7
JournalJournal of the American College of Surgeons
Volume199
Issue number2
DOIs
StatePublished - Aug 1 2004

Fingerprint

Surgical Portasystemic Shunt
Portal Hypertension
Surgical Splenorenal Shunt
Hemorrhage
Transplantation
Liver Transplantation
Endoscopic Hemostasis
Budd-Chiari Syndrome
Hematemesis
Biliary Atresia
Liver Failure
Brain Diseases
Hepatitis C
Portal Vein
Decompression
Angioplasty
Ascites
Pathologic Constriction
Thrombosis
Fibrosis

Keywords

  • CTP
  • Child-Turcotte-Pugh classification
  • DSRS
  • GI
  • PSS
  • distal splenorenal shunt
  • gastrointestinal
  • portosystemic shunt

ASJC Scopus subject areas

  • Surgery

Cite this

Botha, J. F., Campos, B. D., Grant, W. J., Horslen, S. P., Sudan, D. L., Shaw, B. W., & Langnas, A. N. (2004). Portosystemic shunts in children: A 15-year experience. Journal of the American College of Surgeons, 199(2), 179-185. https://doi.org/10.1016/j.jamcollsurg.2004.03.024

Portosystemic shunts in children : A 15-year experience. / Botha, Jean F.; Campos, B. Daniel; Grant, Wendy J.; Horslen, Simon P.; Sudan, Debra L.; Shaw, Byers W.; Langnas, Alan Norman.

In: Journal of the American College of Surgeons, Vol. 199, No. 2, 01.08.2004, p. 179-185.

Research output: Contribution to journalArticle

Botha, JF, Campos, BD, Grant, WJ, Horslen, SP, Sudan, DL, Shaw, BW & Langnas, AN 2004, 'Portosystemic shunts in children: A 15-year experience', Journal of the American College of Surgeons, vol. 199, no. 2, pp. 179-185. https://doi.org/10.1016/j.jamcollsurg.2004.03.024
Botha JF, Campos BD, Grant WJ, Horslen SP, Sudan DL, Shaw BW et al. Portosystemic shunts in children: A 15-year experience. Journal of the American College of Surgeons. 2004 Aug 1;199(2):179-185. https://doi.org/10.1016/j.jamcollsurg.2004.03.024
Botha, Jean F. ; Campos, B. Daniel ; Grant, Wendy J. ; Horslen, Simon P. ; Sudan, Debra L. ; Shaw, Byers W. ; Langnas, Alan Norman. / Portosystemic shunts in children : A 15-year experience. In: Journal of the American College of Surgeons. 2004 ; Vol. 199, No. 2. pp. 179-185.
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abstract = "Background The role of portosystemic shunt (PSS) in children with portal hypertension has changed because of acceptance of liver transplantation and endoscopic hemostasis. We report our experience with PSS, mainly the distal splenorenal shunt, to define its role in the management of variceal bleeding. Study design From 1987 to 2002, 20 children with variceal bleeding after endoscopic therapy underwent PSS. Patient and database records were reviewed. Results There were 14 boys and 6 girls; mean age was 11 years (range 3 to 18 years). Seventeen distal splenorenal and three mesocaval venous interposition shunts were performed. There was no operative mortality, 19 patients were alive at a median followup of 31 months (range 4 to 168 months) without evidence of recurrent gastrointestinal bleeding. One patient underwent transplantation 2 years after PSS and 1 patient died of hepatic failure while awaiting transplantation. The cause of portal hypertension was portal vein thrombosis (n = 13), biliary atresia (n = 3), congenital hepatic fibrosis (n = 2), hepatitis C cirrhosis (n = 1), and Budd-Chiari syndrome (n = 1). Eighteen children were Child-Turcotte-Pugh class A and the remaining two were class B. One patient had two episodes of hematemesis after PSS. Two patients had worsening ascites. One patient had mild encephalopathy and one patient had shunt stenosis requiring angioplasty. Conclusions PSS is a safe and durable therapy for pediatric patients with portal hypertension. Liver transplantation should be reserved for children with poor synthetic function associated with variceal bleeding. PSS may also serve as a bridge to transplantation in patients with preserved hepatic function. PSS, in particular the distal splenorenal shunt, has produced excellent results. This experience challenges the need for alternative forms of portal decompression.",
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