Direct bypassing of extrahepatic portal venous obstruction in children: A new technique for combined hepatic portal revascularization and treatment of extrahepatic portal hypertension

• Published in: Journal of pediatric surgery Vol. 33; no. 4; pp. 597 - 601
• Main Authors: de Ville de Goyet, Jean, Alberti, Daniele, Clapuyt, Philippe, Falchetti, Diego, Rigamonti, Vaifro, Bax, Nikolaas M.A, Otte, Jean-Bernard, Sokal, Etienne M
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01-04-1998; Elsevier
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Feasibility Studies; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Hypertension, Portal - etiology; Hypertension, Portal - surgery; Infant; Jugular Veins - transplantation; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Mesenteric Veins - surgery; Other diseases. Semiology; Pilot Projects; Portal Vein - surgery; Portasystemic Shunt, Surgical - methods; Thrombosis - complications; Thrombosis - surgery; Transplantation, Autologous; Extrahepatic portal hypertension; portal vein thrombosis; hepatic physiology; surgery techniques; Human; Portal circulation disease; Cardiovascular disease; Obstruction; Thrombosis; Venous disease; Vascular disease; Case study; Treatment; Bypass; Surgery; Portal hypertension; Digestive diseases; Technique; Portal vein; Child; Revascularization
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/S0022-3468(98)90324-4

Background:
Decompression of extrahepatic portal hypertension by directly bypassing the thrombosed portal vein has never been reported in cases of children with idiopathic (or neonatal portal vein obstruction and cavernoma.
Methods:
Seven children (15 years or younger) with portal vein obstruction requiring surgical decompression (urgently in two cases), and in whom preoperative Doppler had shown that the intrahepatic portal branches were hypoplastic but free of thrombus, were included in a pilot study. The cavernoma was bypassed by interposing a venous jugular autograft between the superior mesenteric vein and the distal portion of the left portal vein. Patients received follow-up using routine clinical parameters, upper gastrointestinal endoscopy, and Doppler ultrasound.
Results:
The mesenterico-portal bypass restored a direct (physiological) hepatopetal portal flow. The operation resulted in effective portal decompression as demonstrated by decrease of the pressure gradient, rapid regression of clinical signs of portal hypertension, and definitive control of bleeding.
Conclusions:
This study shows that direct bypassing of portal cavernoma is possible and results in effective portal decompression. Restoration of the hepatic portal flow is a major advantage compared with conventional surgical shunting procedures. This new technique is potentially applicable to two thirds of children with portal vein thrombosis and should be considered when shunting procedures are indicated.