REASSESSMENT OF OPERATIVE PROCEDURES FOR PORTAL HYPERTENSION IN INFANTS AND CHILDREN

Experience with the surgical management of portal hypertension in nineteen children treated at the UCLA Hospital has been analyzed. On the basis of this clinical experience certain observations have been made. 1. 1. Patients with portal vein thrombosis (PVT) who survive through childhood may live until late adulthood with decreasing frequency and severity of variceal bleeding. None of the eight patients with PVT in the present series has died. 2. 2. Splenectomy alone does not prevent variceal hemorrhage and may make it difficult to visualize or shunt the portal venous system later. 3. 3. Gastrectomy may delay but not prevent bleeding and may be a cause of morbidity in itself. 4. 4. Medical therapy will control hemorrhage in most small children with PVT until they are of sufficient size to undergo a shunt operation. 5. 5. Variceal bleeding is not without risk in children with PVT and emergency variceal ligation may be necessary. 6. 6. End to side mesocaval, splenorenal, or portacaval shunts are preferred when feasible in children with PVT. Makeshift shunts are unsatisfactory. Distal splenorenal anastomosis is recommended when the splenic vein is thrombosed. 7. 7. Many children with intrahepatic portal venous obstruction have mild hepatocellular disease and may experience a good prognosis if variceal hemorrhage is controlled by a shunt. An aggressive approach is recommended in these children who frequently do not tolerate variceal hemorrhage well. 8. 8. Long-term chemotherapy with hepatotoxic drugs may produce hepatic scarring and portal hypertension which is amenable to shunt procedures. 9. 9. Side to side or end to side portacaval anastomoses are preferred in children with intrahepatic portal obstruction and may be performed successfully even in young children. © 1969.