Antonio-Sandoval L, Yamamoto-Nagano A, Ortiz-Galván RC, L-Hernández A, Diego-Pérez J

Language: Spanish
References: 11
Page: 106-113
PDF size: 297.73 Kb.

ABSTRACT

Introduction: The distal splenorenal shunt (DERD), selective portosystemic shunt has the advantage slow the progression of hepatic encephalopathy, events of upper gastrointestinal bleeding. We aim to establish that the DERD can be performed in pediatric patients having the same benefits as adults.
Material and methods: retrospective, observational, transversal, in patients with portal hypertension and hypersplenism, any genre, two or more episodes of gastrointestinal bleeding, aged between 12 and 203 months, operated as a portosystemic shunt. Records were reviewed in September 2004 to September 2006.
Results: We evaluated 11 patients with pulmonary hypertension secondary to portal cavernomatosa degeneration (PCD) (63.6%), cryptogenic cirrhosis (27.3%), choledochal cyst (9%), 6 men and 5 women, median age 72 (19-146) months and weight 20.5 (13.3-44) kg, followed for 7-19 months. We DERD 7, 2 and 2 leads mesocaval Sugiura procedures. No thrombosis or complications. After the shunt was no increase in platelet count (p 0.04), hospital stay was less than 10 days, two patients had a weight below 15 kilograms.
Discussion: In our study the most common cause of HP is the DCP. Although there are no reports in children weighing 20 kg for the high risk of stenosis or thrombosis, our patients recovered well during the 19 months follow up.

REFERENCES

1. O’Neill J A, Rowe M, Grosfeld J, Fonkalsrud E W, Coran A G. Pediatric Surgery, 5ta. edición, Baltimore: Mosby Editorial, 1998; Vol 2: p 1513-1526.

2. McGrogan P J, Hodges S, Management and outcome of portal hypertension in children, Current Paediatrics 2001;11:90-95.

3. Bosch J, Abraldes J G, Groszmann R, Current management of portal hypertension, J of Hepatology 2003;38:S54-S68.

4. Sung J J, Tong Y, Leong R W, EUS in portal hypertension, Gastrointestinal endoscopy 2002;56:4, S35-S43

5. 5 Sanyal A, The value of EUS in the management of portal hypertension, Gastrointestinal endoscopy 2000; 52:4, 575-577.

6. Botha JF, Campos B D, Grant W, Horslen S, Sudan D. Portosystemic shunts in children: A 15 year experience, J AM Coll Surg 2004;199:2,179-185.

7. Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension: Variceal hemorrhage, ascites and spontaneous bacterial peritonitis, Gastroenterology 2001;120:726-748

8. Franchis R. Evolving consensus in portal hypertension report of the Baveno IV Consensus Workshop on methodology of diagnosis and therapy in portal hypertension, J of Hepatology 2005;43:167-176.

9. Melo V A, Melo GB, Ceneviva R. Splenic artery ligation and distal splenorenal shunt in schistosomiasis, J of Surgical Research 2004;121:1, 108-111.

10. Knechtle S, D’Alessandro A, Armbrust M, Musat A, Kalayoglu M. Surgical portosystemic shunts for treatment of portal hypertensive bleeding: Outcome and effect on liver function, Surgery 1999;126:4, 708-713.

11. Zollinger R Jr, Zollinger R Sr. Atlas of surgical operations, 8va. Edición. Estados Unidos de Norteamérica: Mc Graw Hill Editorial, 2003; p 336 – 347.