Meso-Rex shunt for extrahepatic portal vein obstruction in children

Godik, O.S.; Diehtiarova, D.S.; Dubrovin, О.G.

doi:10.1016/j.ijsu.2022.106374

Cited by 2 publications

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“…The meso-Rex surgery is recommended as a main surgical approach to EHPVO but is limited by favorable anatomy presence and surgeon's expertise [7]. Widespread use of surgical treatment methods and long-term study results has led to a better understanding of the causes and consequences of portohepatic circulation in children with PH [15].…”

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confidence: 99%

The role of variceal bleeding primary prophylaxis in the management of extrahepatic portal vein obstruction in children

Godik,

Voroniak,

Diehtiarova

2023

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Extrahepatic portal vein obstruction is a major cause of pediatric symptomatic portal hypertension and can lead to profuse variceal hemorrhaging. Purpose - to evaluate the role of primary prophylaxis of the variceal bleeding in children with extrahepatic portal vein obstruction. Materials and methods. A one-center prospective cohort clinical study involved 120 patients with extrahepatic portal vein obstruction who underwent primary or secondary variceal bleeding prophylaxis in 2016-2021. The laboratory, ultrasound, and endoscopy data before and after treatment were collected and evaluated. Results. Variceal bleeding episodes occurred in 5.8% (n=3) of patients who underwent primary prophylaxis and rebleeding occurred in 27.9% (n=19) of those who underwent secondary prophylaxis. Bleeding episodes occurred less frequently in patients from primary prophylaxis group (p=0.013). In patients treated endoscopically (n=53, 44.17%) Variceal bleeding appeared less frequently (n=3, 5.66%) after treatment compared to patients who underwent surgery (n=67 (55.83%), 19 had rebleeding (28.35%)) (p=0.001). In 69.17% patients (n=83) esophageal varices eradication was achieved: in 53.01% (n=44) patients from the primary prophylaxis group and 46.99% (n=39) from the secondary prophylaxis group. Bleeding episodes occurred less frequently after the eradication achievement (p<0.001). The primary prophylaxis led to varices eradication more often than secondary (p=0.003). The varices recurrence episodes rates after the eradication achievement were not different between groups (p=0.51). Conclusions. Primary prophylaxis can reduce the bleeding risk in extrahepatic portal vein obstruction with high risk of variceal bleeding. The prophylaxis by endoscopic variceal banding is an important bridge in the treatment for pediatric patients with portal hypertension that along with portosystemic shunting could potentially improve prophylactic treatment results. The Committee on Clinical Investigation of Bogomolets National Medical University approved this study (Protocol No.141, 27.01.2021). All the studies were conducted according to implemented guidelines in consideration of GCP-ICH and Declaration of Helsinki. The written informed consent of all participants’ parents/guardians was achieved. No conflict of interests was declared by the authors.

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Section: Introductionmentioning

confidence: 99%

The role of variceal bleeding primary prophylaxis in the management of extrahepatic portal vein obstruction in children

Godik,

Voroniak,

Diehtiarova

2023

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Analysis of the effectiveness of the method of primary bleeding prevention in the treatment of portal hypertension in children

Godik

2024

UJCS

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Objective. To evaluate the role of primary prevention of variceal bleeding in children with prehepatic portal vein obstruction. Materials and methods. The single–centre prospective cohort clinical trial involved 120 patients with extrahepatic obstruction of the hepatic portal vein who underwent primary or secondary prevention of variceal bleeding in 2016–2021. Laboratory, ultrasound, and endoscopic data were collected and evaluated before and after prophylactic treatment. Results. Episodes of variceal bleeding were observed in 3 (5.78%) patients who received primary prophylaxis, and rebleeding occurred in 19 (27.94%) patients who received secondary prophylaxis (p=0.013). Of the 53 (44.17%) patients who underwent endoscopic treatment, variceal bleeding occurred in 3 (5.66%), and 19 (28.36%) of the 67 (55.83%) patients who underwent surgery experienced rebleeding (p=0.001). Esophageal varices eradication was achieved in 83 (69.17%) patients: 44 (53.01%) patients who received primary prevention and 39 (46.99%) patients who received secondary prevention. Bleeding episodes occurred less frequently after eradication (p<0.001). After primary prevention, varicose veins disappeared more often than after secondary prevention (p=0.003). The incidence of varicose veins recurrence after achieving eradication did not differ in the groups (p=0.51). Conclusions. Primary prevention can reduce the high risk of bleeding in prehepatic portal vein obstruction. Prophylactic endoscopic ligation is important in the treatment of portal hypertension in children, which, together with portosystemic shunting, can potentially improve the results of preventive treatment.

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Meso-Rex shunt for extrahepatic portal vein obstruction in children

Cited by 2 publications

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The role of variceal bleeding primary prophylaxis in the management of extrahepatic portal vein obstruction in children

The role of variceal bleeding primary prophylaxis in the management of extrahepatic portal vein obstruction in children

Analysis of the effectiveness of the method of primary bleeding prevention in the treatment of portal hypertension in children

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