A modified technique of devascularization for surgical management of portal hypertension in children

In developing countries surgery is indicated in patients with portal hypert ension for a variety of reasons. This study prospectively evaluates a modif ied technique of devascularization for secondary prophylaxis of variceal bl eeding in patients with portal hypertension of different aetiologies. Transabdominal extensive oesophagogastric devascularization combined with t ransmural ligation of oesophageal and gastric varices was performed in 16 p aediatric patients (nine with extra hepatic portal venous obstruction, and seven with non-cirrhotic portal fibrosis) in an elective setting. The Sugiu ra devascularization procedure was modified to minimize the operating time and to avoid the problems associated with oesophageal transection and anast omosis. The operative mortality rate as well as the oesophageal leak rate was zero. One patient developed an oesophageal stricture. During a 12-month follow-u p, patients were seen with residual varices (2), recurrent varices (3) and rebleeding (1). Porto-systemic encephalopathy was seen in one patient only. This technique is a simple, straightforward, safe and effective modificatio n of the Sugiura procedure in controlling bleeding, providing good quality of life with minimal porto-systemic encephalopathy.