SURGERY FOR PORTAL HYPERTENSION IN

CHILDREN: A 12-YEAR REVIEW

Definition

Classification

Classification

Aetiology:

(i) Hepatocellular disease with liver fibrosis

(ii) Primary vascular abnormalities

Underlying pathophysiology:

(i) Resistance to flow

(ii) Increase flow

(iii) Both

Presentation

A: Ascites

B: Bleeding

C: Caput Medusae

D: Diminished Liver

E: Enlarged Spleen

Presentation

Surgical Indications

Uncontrolled bleeding from oesophageal varices

Bleeding gastric or ectopic varices

Hypersplenism or massive splenomegaly

Symptomatic biliopathy

Isolated EHPVO

Limited access to endoscopy

Patient choice

Types of surgery

Physiological vs non-physiological

Rex Shunt

Non-Selective Portosystemic Shunt (PSS)

(i) Total

(ii) Partial

Selective PSS

Risk of encephalopathy balanced against risk of

rebleeding

Types of surgery

Study aims

Demographic profile

Surgical indication

Surgical technique

Complications

Methods

Retrospective record review

12 year period (2005-2017)

Chris Hani Baragwanath Academic Hospital

Charlotte Maxeke Johannesburg Academic Hospital

Wits Donald Gordon Medical Centre

Sandton Mediclinic

Ethics approval (M170647)

Results

14 shunt procedures

12 children

6 male

Median age 6.5 years

Range 1 – 18 years

Results

Results

Results

Going Forward

Surgery remains relevant

(i) Cure

(ii) Bridge to transplantation

Choice of surgery

Collaboration with paediatric hepatologists

Follow up study in 5 – 10 years

Gaps in data collection

References

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Thanks