Thomas Blanc1, Florent Guerin, Stéphanie Franchi-Abella, Emmanuel Jacquemin, Danièle Pariente, Olivier Soubrane, Sophie Branchereau, Frédéric Gauthier. 1. *Department of Pediatric Surgery, Univ Paris Sud, Hôpitaux Universitaires Paris Sud, APHP, Le Kremlin Bicêtre France †Department of Pediatric Surgery, Univ Paris Descartes, Sorbonne Paris Cité, Hôpital Necker Enfants Malades, APHP, Paris, France ‡Department of Pediatric Radiology, Univ Paris Sud, Hôpitaux Universitaires Paris Sud, APHP, Le Kremlin Bicêtre France §Department of Pediatric Hepatology, Univ Paris Sud, Hôpitaux Universitaires Paris Sud, APHP, Le Kremlin Bicêtre France ¶Department of Hepato-biliary Surgery and Liver Transplantation, Univ Pierre et Marie Curie, Hôpital Saint Antoine, APHP, Paris, France.
Abstract
OBJECTIVE: To propose an anatomical classification of congenital portosystemic shunts (CPSs) correlating with conservative surgery. BACKGROUND: CPSs entail a risk of life-threatening complications because of poor portal inflow, which may be prevented or cured by their closure. Current classifications based on portal origin of the shunt are not helpful for planning conservative surgery. METHODS: Twenty-three patients who underwent at least 1 surgical procedure to close the CPSs were included in this retrospective study (1997-2012). We designed a classification according to the ending of the shunt in the caval system. We analyzed the results and outcomes of surgery according to this classification. RESULTS: Two patients had an extrahepatic portosystemic shunt, 17 had a portacaval shunt [subdivided in 5 end-to-side-like portal-caval, 7 side-to-side-like portal-caval, and 5 H-shaped (H-type portal-caval)], 2 had portal-to-hepatic vein shunts (portohepatic), and 2 had a persistent ductus venosus. All extrahepatic portosystemic shunts, H-type portal-caval, portohepatic, and patent ductus venosus patients had a successful 1-stage ligation. All 5 end-to-side-like portal-caval patients had a threadlike intrahepatic portal venous system; a 2-stage complete closure was successfully achieved for 4 and a partial closure for 1. The first 2 side-to-side-like portal-caval patients had a successful 2-stage closure whereas the 5 others had a 1-stage longitudinal caval partition. All patients are alive and none needed a liver transplantation. CONCLUSIONS: Our classification correlates the anatomy of CPSs and the surgical strategy: outcomes are good provided end-to-side-like portal-caval shunts patients have a 2-stage closure, side-to-side portal-caval shunts patients have a 1-stage caval partition, and the others have a 1-stage ligation.
OBJECTIVE: To propose an anatomical classification of congenital portosystemic shunts (CPSs) correlating with conservative surgery. BACKGROUND: CPSs entail a risk of life-threatening complications because of poor portal inflow, which may be prevented or cured by their closure. Current classifications based on portal origin of the shunt are not helpful for planning conservative surgery. METHODS: Twenty-three patients who underwent at least 1 surgical procedure to close the CPSs were included in this retrospective study (1997-2012). We designed a classification according to the ending of the shunt in the caval system. We analyzed the results and outcomes of surgery according to this classification. RESULTS: Two patients had an extrahepatic portosystemic shunt, 17 had a portacaval shunt [subdivided in 5 end-to-side-like portal-caval, 7 side-to-side-like portal-caval, and 5 H-shaped (H-type portal-caval)], 2 had portal-to-hepatic vein shunts (portohepatic), and 2 had a persistent ductus venosus. All extrahepatic portosystemic shunts, H-type portal-caval, portohepatic, and patent ductus venosuspatients had a successful 1-stage ligation. All 5 end-to-side-like portal-caval patients had a threadlike intrahepatic portal venous system; a 2-stage complete closure was successfully achieved for 4 and a partial closure for 1. The first 2 side-to-side-like portal-caval patients had a successful 2-stage closure whereas the 5 others had a 1-stage longitudinal caval partition. All patients are alive and none needed a liver transplantation. CONCLUSIONS: Our classification correlates the anatomy of CPSs and the surgical strategy: outcomes are good provided end-to-side-like portal-caval shunts patients have a 2-stage closure, side-to-side portal-caval shunts patients have a 1-stage caval partition, and the others have a 1-stage ligation.
Authors: Frank DiPaola; Andrew T Trout; Ashley E Walther; Anita Gupta; Rachel Sheridan; Kathleen M Campbell; Greg Tiao; Jorge A Bezerra; Kevin E Bove; Manish Patel; Jaimie D Nathan Journal: Dig Dis Sci Date: 2019-09-23 Impact factor: 3.199