Peculiarities of mesoportal shunt surgical technique and its efficiency in treatment of children with portal hypertension

Abstract

Modern methods of surgical treatment of the prehepatic form of portal hypertension (PPH) aim to prevent bleeding from esophagus varicose veins and to restore liver portal perfusion. The use of mesoportal shunt (MPS) in patients with PPH is limited by the presence of favorable anatomy in the latter. The standardization of the diagnostic procedures volume, stages of surgery technical performance will help to significantly improve the results of treatment of children with PHP, to which indications for the MPS were established. Purpose - to evaluate the possibility of performing, efficiency and safety of MPS in children with portal hypertension, the degree of esophageal varicose veins involution and reducing the spleen volume reduction. Materials and methods. Case histories of 20 children who underwent surgical treatment of PPH by means of MPS in the period from January 2010 to June 2022 were retrospectively studied. The median follow up was 85.6±14.17 months. The surgical technique used is presented in detail. Results. Male predominance is seen (12 boys, 8 girls) in the study group. The average age at the moment of diagnosis was 7.6±0.88 years. In 13 (65%) cases, an episode of bleeding from varicose veins of the esophagus was the first clinical manifestation. Endoscopic examination revealed II-III degree esophageal varices in 17 (85%) children. All patients had splenomegaly with an average spleen volume of 507.7±67.7 cm3. 8 (40%) patients had severe hypersplenism. The median MPS operational time was 326 (95% CI 300-371) minutes. In 7 (35%) cases shunt thrombosis occured, in 1 (14.2%) case thrombectomy was performed. The overall MPS efficiency of 70% was reached. None of the patients of the follow up group had recurrency of esophageal bleeding. Conclusions. The possibility of performing the MPS depends on favorable anatomy; CT is the optional diagnostic method to detect it, but the role of direct intraoperative visualization and the performance of intraoperative intrahepatic portography remains highly valuable. The 5-year MPS survival rate was 72.2±10.6%. 1 year after surgery, MPS resulted into the involution of the esophageal varices (p<0.001) and a decrease in the volume of the spleen (p<0.001). The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.