PROXIMAL SPLENORENAL SHUNTS FOR EXTRAHEPATIC PORTAL VENOUS OBSTRUCTION IN CHILDREN

Objective The results of proximal splenorenal shunts done in children with extrahepatic portal venous obstruction were evaluated. Summary Ba ckground Data Extrahepatic portal venous obstruction, a common cause o f portal hypertension in children in India, is being treated increasin gly by endoscopic sclerotherapy instead of by proximal splenorenal shu nt. It is believed that surgery (or the operation) carries high mortal ity and rebleeding rates and is followed by portosystemic encephalopat hy and postsplenectomy sepsis. However, a proximal splenorenal shunt i s a definitive procedure that may be more suitable for children, parti cularly those who have limited access to medical facilities and safe b lood transfusion. Methods Between 1976 and 1992, the authors performed 160 splenorenal shunts in children. Twenty were emergency procedures for uncontrollable bleeding and 140 were elective procedures - 102 for recurrent bleeding and 38 for hypersplenism. Results The overall oper ative mortality rate was 1.9%-10% (3/160-2/20) after emergency operati ons and 0.7% (1/140) after elective operations. Rebleeding occurred in 17 patients (11%), and pneumococcal meningitis developed in 1 patient who recovered later. Encephalopathy did not develop in any patient. F our patients died in the follow-up period - two of rebleeding, one of chronic renal failure and a subphrenic abscess, and one of unknown cau ses. The 15-year survival rate by life table analysis was 95%. Conclus ions A proximal splenorenal shunt, a one-time procedure with a low mor tality rate and good long-term results, is an effective treatment for children in India with extrahepatic portal venous obstruction.