National Medical University, Ukraine
Background: Extrahepatic portal vein occlusion (EHPVO), remains one of the most common reasons of portal hypertension in pediatrics. More than a half of our patients (56,2%) sought for medical attention for the reason of acute variceal hemorrhage. Despite the improvement in and endoscopic control, most patients require a surgical procedure to be performed to achieve the elimination of bleeding or re-bleeding risks. Shunt surgery is usually indicated when the ultimate cause is possible to be treated, that results in the portal pressure normalizing with the following decreasing of the variceal bleeding risks. We addressed contemporary outcomes of surgical treatment of portal hypertension in our hospital. Materials and methods: A retrospective study on 624 children with portal hypertension that underwent treatment in our Children’s Specialized Hospital “OHMADYT” during the last 15 years (from October 2003 to August 2018). The age of patients varied from 4 months to 18 years. The EHPVO presented in 74 % (n= 460) children. Umbilical vein catheterization 36,3 % (n= 167) was found to be the primary etiologic reason for the EHPVO development. Cavernous transformation of the portal vein persisted in 83,2 % (n= 383) children. More than half of the patients presented with acute variceal bleeding – 62% (n= 289). There were 136 (24,8 %) surgical procedures performed with devascularization operations (16 of them were Sugiura-Futagawa operation), 325 (59,4%) splenorenal shunts, 71 (12,9%) mesocaval shunts and 15 (2,7 %) mesoportal shunts. Results: Surgical procedures efficacy was evaluated according to the acute variceal bleeding episodes recuperation. The efficacy of devascularization operations was 61,1 %, of splenorenal shunt – 84,5 %, of mesocaval shunt – 92.5 % and 80 % for mesoportal shunt by this indicant. Conclusion: In comparison to of devascularization operations, shunt procedures in children with portal hypertension showed efficacy range 61,1 – 90,3 %, and therefore we consider them to be the better choice for such a patients.