Late results of a modified new surgical procedure for the treatment of portal hypertension.

PURPOSE: The aim of this study is to report on the late results of the modified surgical procedure "subtotal splenectomy with omentopexy and partial splenic attachment to the parietal peritoneum" for the treatment of portal hypertension in children.

METHODS

Over a period of twenty years (1984 - 2004), two modifications have been performed of the procedure of "partial splenectomy and partial splenic attachment for the treatment of portal hypertension", which were reported in the Zeitschrift für Kinderchirurgie [ ], in 1990. The modifications were due to the recurrence of splenomegaly in five cases, with signs of hypersplenism in three of them after ten years.

RESULTS

The follow-up ranges between one and fourteen years. All the patients are in good health, with good growth and development, except for one case with liver failure due to liver cirrhosis. No mortality occurred in this group of patients. Severe bleeding occurred in only one case after four years. Treatment consisted of sclerotherapy and ligation of the splenic artery. Splenomegaly was found in five cases, with hypersplenism in three of them. Splenic artery embolisation in two cases and ligation in one case produced good results. Howell-Jolly bodies were negative in all cases and radionuclide scan showed satisfactory to good results in most cases. Good results were also obtained in the studies of immunoglobulins and complements in most cases, with two exceptions of reduced IGM in one case and C4 in the other.

CONCLUSIONS

Subtotal splenectomy with omentopexy and partial splenic attachment is a good alternative to other operative procedures for the treatment of portal hypertension. With this method, the precipitation and increase in collateral circulation leads to rapid improvement.