Portosystemic shunting in children during the era of endoscopic therapy: Improved postoperative growth parameters

Background: Surgical portosystemic shunting has been performed less frequen tly in recent years. In this retrospective study, recent outcomes of portos ystemic shunting in children are described, to evaluate its role in the era of endoscopic therapy. Methods: Retrospective chart review of children who underwent surgical port osystemic shunt procedures between October 1994 and October 1997. Results: Twelve children (age range, 1-16 years) underwent shunting procedu res. The causes of portal hypertension were extrahepatic portal vein thromb osis (n = 6), congenital hepatic fibrosis (n = 2), hepatic cirrhosis (n = 2 ), and other (n = 2). None of the patients were immediate candidates for li ver transplantation. Types of shunt included: distal splenorenal (n = 10), portocaval (n = 1), and other (n = 1). Median follow-up was 35 months (rang e, 24-48 months). All patients are currently alive and well with patent shu nts. The mean hospital stay was 8 days. Three patients required readmission for further interventions because of shunt stenosis in two and small bowel obstruction in the other. Mild portosystemic encephalopathy was seen in on e child with pre-existing neurobehavioral disturbance. Excluding a patient who underwent placement of a portosystemic shunt for a complication of Live r transplantation, mean weight-for-age z score in nine prepubertal patients improved from -1.16 SD to +0.15 SD (P = 0.023), and mean height-for-age z score from -1.23 SD to 0.00 SD (P = 0.048) by 2 years after surgery. Conclusions: Surgical portosystemic shunting is a safe and effective method for the management of portal hypertension in childhood. Patients show sign ificant improvements in growth parameters after the procedure. Surgical por tosystemic shunting should be actively considered in selected children with portal hypertension.