Surgical treatment of portal hypertension in children
Fabrizio di Francesco, Jean de Ville de Goyet1
1Epatologia e Trapianto di Fegato Pediatrico IRCCS ISMETT, Palermo
The management of children with portal hypertension hasdramatically changed during the past decade, with animprovement in outcome. This has been achieved mostlyby an increasingly more efficient control of varices byendoscopy and the success of liver transplantation.Although the indications for surgical portosystemic shuntshave reduced in recent decades, they are still indicated fornon-cirrhotic portal hypertension – mostly patients withpre-hepatic portal hypertension and some rare conditionswhere the primary disease can be cured before the liverparenchyma is damaged by chronic secondary changes(Budd-Chiari syndrome). In children with pre-hepaticportal hypertension, the meso-Rex bypass is now a goldstandard and can even be proposed preemptively, but islimited to those patients with a favorable anatomy. Incirrhotic patients, elective portosystemic shunt surgery isreserved for failure to respond to conservativemanagement in the absence of alternative therapies andin selected cases with well-preserved hepatic function.