Surgical management of portal hypertension in children

Research output: Contribution to journalArticle

Abstract

The management of children with portal hypertension has dramatically changed during the past decade, with an improvement in outcome. This has been achieved by improved efficiency of endoscopic variceal control and the success of liver transplantation. Emergency surgical shunt procedures are rarely required, with acute bleeding episodes generally controlled endoscopically or, occasionally in adults, by interventional radiological procedures. Portosystemic shunts may be considered as a bridge to transplant in adults but are rarely used in this context in children. Nontransplant surgery or radiological interventions may still be indicated for noncirrhotic portal hypertension when the primary cause can be cured and to allow normalization of portal pressure before liver parenchyma is damaged by chronic secondary changes in some specific diseases. The meso-Rex bypass shunt is used widely but is limited to those with a favorable anatomy and can even be performed preemptively. Elective portosystemic shunt surgery is reserved for failure to respond to conservative management in the absence of alternative therapies.

Original languageEnglish
Pages (from-to)219-232
Number of pages14
JournalSeminars in Pediatric Surgery
Volume21
Issue number3
DOIs
Publication statusPublished - Aug 2012

Keywords

  • Liver transplantation
  • Meso-Rex bypass
  • Portal hypertension
  • Portosystemic shunts

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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