DIRECT BYPASSING OF EXTRAHEPATIC PORTAL VENOUS OBSTRUCTION IN CHILDREN - A NEW TECHNIQUE FOR COMBINED HEPATIC PORTAL REVASCULARIZATION AND TREATMENT OF EXTRAHEPATIC PORTAL-HYPERTENSION

Background: Decompression of extrahepatic portal hypertension by direc tly bypassing the thrombosed portal vein has never been reported in ca ses of children with idiopathic (or neonatal) portal vein obstruction and cavernoma. Methods: Seven children (15 years or younger) with port al vein obstruction requiring surgical decompression (urgently in two cases), and in whom preoperative Doppler had shown that the intrahepat ic portal branches were hypoplastic but free of thrombus, were include d in a pilot study. The cavernoma was bypassed by interposing a venous jugular autograft between the superior mesenteric vein and the distal portion of the left portal vein. Patients received follow-up using ro utine clinical parameters, upper gastrointestinal endoscopy, and Doppl er ultrasound. Results: The mesenterico-portal bypass restored a direc t (physiological) hepatopetal portal flow. The operation resulted in e ffective portal decompression as demonstrated by decrease of the press ure gradient, rapid regression of clinical signs of portal hypertensio n, and definitive control of bleeding. Conclusions: This study shows t hat direct bypassing of portal cavernoma is possible and results in ef fective portal decompression. Restoration of the hepatic portal flow i s a major advantage compared with conventional surgical shunting proce dures. This new technique is potentially applicable to two thirds of c hildren with portal vein thrombosis and should be considered when shun ting procedures are indicated. Copyright (C) 1998 by W.B. Saunders Com pany.