surgery for portal hypertension in children: a 12-year … for portal... · surgery for portal...

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.

J Am Coll Surg 2004;199(2):179-185. https://doi.org/10.1016/j.amcollsurg.2004.03.024

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