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

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.