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38 - Portal hypertension

from Part IV - Abdomen

Published online by Cambridge University Press:  08 January 2010

Frédéric Gauthier
Affiliation:
Division of Surgery, Federation of Paediatrics, Centre Hospitalier Universitaire Bicêtre, France
Danièle Pariente
Affiliation:
Division of Radiology, Federation of Paediatrics, Centre Hospitalier Universitaire Bicêtre, France
Sophie Branchereau
Affiliation:
Division of Surgery, Federation of Paediatrics, Centre Hospitalier Universitaire Bicêtre, France
Mark D. Stringer
Affiliation:
Children's Liver and GI Unit, St James's University Hospital, Leeds, UK
Mark D. Stringer
Affiliation:
University of Otago, New Zealand
Keith T. Oldham
Affiliation:
Children's Hospital of Wisconsin
Pierre D. E. Mouriquand
Affiliation:
Debrousse Hospital, Lyon
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Summary

Gastrointestinal bleeding related to portal hypertension (PH) in children may be life threatening. Therapeutic alternatives used to relieve PH and reduce the risk of bleeding include various types of surgical and radiologic vascular procedures. Shunt surgery, which usually results in total diversion of portal blood flow, was introduced several decades ago. The long-term benefits and complications of this therapy have been critically reviewed in the previous edition of this book. New techniques developed during the 1990s. The transjugular intrahepatic porto-systemic stent shunt (TIPS) is now preferred to surgical shunts for treatment of PH in most cirrhotic patients. The splanchnic-to-left-portal vein bypass (Rex shunt), designed for definitive treatment of portal vein obstruction, results in restoration of physiologic intrahepatic portal blood flow. The less invasive techniques of percutaneous endoluminal dilatation or thrombectomy of the portal vein, with or without placement of a stent, have been used mainly as rescue therapies after failed shunts, TIPS or bypasses; a few attempts have been made to use them as a definitive treatment of portal vein obstruction.

Shunt surgery

Evolution of indications for shunt surgery

Different pathologic conditions cause portal hypertension in children and etiology must be considered when choosing a treatment for PH. In the case of extrahepatic portal obstruction (EHPO), which is either idiopathic or a complication of perinatal thrombosis of the portal vein, liver function is normal or near-normal, and for many years a shunt operation has been considered as the best method of providing lifetime protection against recurrence of bleeding, with an acceptable risk of complications.

Type
Chapter
Information
Pediatric Surgery and Urology
Long-Term Outcomes
, pp. 491 - 509
Publisher: Cambridge University Press
Print publication year: 2006

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