Functional side-to-side splenorenal shunts to treat extrahepatic portal vein thrombosis in children

Surgical shunts are commonly used to manage complications resulting from extrahepatic portal vein thrombosis (EHPVT) in children. We describe a single-center experience utilizing a functional Side-to-Side Splenorenal Shunt (fSRS), created using either an enlarged inferior mesenteric vein (IMV) or le...

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Bibliographic Details
Published in:The American journal of surgery Vol. 224; no. 1; pp. 530 - 534
Main Authors: Yang, Alexander Y., Slatnick, Brianna L., Durgin, Jonathan, Truche, Paul, Kim, Heung Bae, Cuenca, Alex G.
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.07.2022
Elsevier Limited
Subjects:
Anastomosis
Ascites
Children
Complications
Dissection
Endoscopy
Extrahepatic portal hypertension
Hypertension
Length of stay
Liver
Medical imaging
Patients
Pediatrics
Portal vein
Portal vein thrombosis
Postoperative
Shunts
Splenorenal shunt
Surgeons
Thromboembolism
Thrombosis
Tomography
Urinary tract diseases
Urinary tract infections
Urogenital system
Veins & arteries
Splenorenal shunt
Extrahepatic portal hypertension
Portal vein thrombosis
ISSN:0002-9610, 1879-1883, 1879-1883
Online Access:Get full text
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Summary:Surgical shunts are commonly used to manage complications resulting from extrahepatic portal vein thrombosis (EHPVT) in children. We describe a single-center experience utilizing a functional Side-to-Side Splenorenal Shunt (fSRS), created using either an enlarged inferior mesenteric vein (IMV) or left adrenal vein (LAV). Pediatric patients with isolated EHPVT who were poor candidates for a Rex shunt and who underwent a fSRS procedure at our institution between 2003 and 2020 were reviewed. The pre/post shunt portosystemic gradient change, rates of early and late complications, postoperative shunt patency, and mortality were evaluated. Twelve EHPVT patients (mean age of 6.1 years) underwent a fSRS procedure. The mean portosystemic gradient change for the cohort was −11.7 mmHg (±4.9). There were no cases of recurrent variceal bleeding or episodes of shunt thrombosis reported after fSRS procedures. Surgical shunts continue to be an important adjunct in the treatment of complications related to EHPVT. The functional Side-to-Side Splenorenal Shunt is a safe alternative that is easy to perform, involves minimal dissection and requires only a single anastomosis. •Surgical shunts are a definitive treatment for portal hypertension secondary to portal vein thrombosis in children.•Existing surgical shunts require extensive dissection and have been associated with high thrombosis rates.•We describe our experience utilizing a shunt created using either an enlarged mesenteric or adrenal vein.•Our shunt technique provides an effective alternative to existing shunt techniques.
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ISSN:0002-9610
1879-1883
1879-1883
DOI:10.1016/j.amjsurg.2022.01.031