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SURGERY FOR PORTAL HYPERTENSION IN
CHILDREN: A 12-YEAR REVIEW
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Definition
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Classification
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Classification
Aetiology:
(i) Hepatocellular disease with liver fibrosis
(ii) Primary vascular abnormalities
Underlying pathophysiology:
(i) Resistance to flow
(ii) Increase flow
(iii) Both
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Presentation
A: Ascites
B: Bleeding
C: Caput Medusae
D: Diminished Liver
E: Enlarged Spleen
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Presentation
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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
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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
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Types of surgery
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Study aims
Demographic profile
Surgical indication
Surgical technique
Complications
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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)
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Results
14 shunt procedures
12 children
6 male
Median age 6.5 years
Range 1 – 18 years
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Results
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Results
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Results
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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
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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
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Thanks