Treatment of extrahepatic portal hypertension in children by mesenteric- to-left portal vein bypass: A new physiological procedure

Abstract

Objective: To achieve hepatic portal revascularisation and decompression of extrahepatic portal hypertension in children with cavernoma and obstruction caused by idiopathic portal vein thrombosis. Design: Selected cases. Setting: Teaching hospitals, Belgium and Italy. Subjects: 11 children who weighed between 5.9 and 54 kg (2 emergencies) with symptomatic extrahepatic portal hypertension. Intervention: Interposition of venous autograft between the superior mesenteric vein and the distal (umbilical) portion of the left portal vein. Main outcome measures: Improvements in symptoms and endoscopic appearance after operation. Results: 2 bypasses had to be redone because they stenosed; all 11 were patent at the time of writing (median follow-up 6 months, range 1-32 months). Conclusion: The bypass effectively relieved symptoms of extrahepatic portal hypertension by restoring normal hepatic portal blood flow.