LONG-TERM OUTCOME AFTER SURGERY FOR EXTRAHEPATIC PORTAL-VEIN THROMBOSIS

The long term outcome of 21 children with extrahepatic portal hyperten sion secondary to portal vein thrombosis managed by surgical intervent ion was evaluated. Portosystemic shunts, used primarily in nine patien ts (eight central splenorenal, one mesocaval) after conservative treat ment had failed, had no associated mortality and a 56% patency rate. F ive of these shunted patients had no further bleeding episodes and did not show encephalopathic impairment. Direct attack procedures - porto azygos operation (four patients) was associated with significant compl ications, including one fatality. Other direct approaches oesophageal transection and variceal plication (five patients) had variable outcom e. Splenectomy alone (three patients) ameliorated hypersplenism; howev er, further surgery for recurrent haemorrhage (two patients) was neces sary. Endoscopic sclerotherapy controlled recurrent variceal bleeding (three patients) when it became available to the unit. Conservative tr eatment practised in five children had little success: two patients su rvived, two died from further haemorrhage, and one was lost to follow up. These results suggest that in centres without endoscopic expertise , and for patients who are sclerotherapy 'failures', surgery can be pe rformed safely and achieve a reasonable long term success rates in chi ldhood extrahepatic portal hypertension.