Selective devascularisation of stomach and lienopulmopexy for prevention of bleedings in portal hypertension in children.

Dissatisfied with different operative procedures for prevention of recurrent bleedings in childhood portal hypertension, many surgeons nowadays treat their patients conservatively during episodic attacks and advocate one of the shunt procedures in adolescence when the splenic vein becomes sufficiently widened (more than 1 cm). Even then mortality cannot be avoided in some bad risk patients especially those living in remote villages lacking facilities for blood transfusion and high speed transport service. In this situation thoracic transposition of spleen and lienopulmopexy was advocated by Nylander and Turumen, Auvert, M. Bettex and others. We prefer a further simpler procedure and perform selective devascularisation of stomach and lienopulmopexy. It allows rapid development of collaterals between splenic pulps on the portal side and subpleural venous plexus on the systemic side to achieve effective gastric devascularisation to prevent further bleeding without hindering the existing portal flow through the liver to avoid the possible occurrence of encephalopathy. Of 21 operated cases one died on the 5th postoperative day and the remaining 20 are doing well. 1/2-5 1/2 years' follow-up revealed negligible morbidity and no recurrence of bleeding in any of them. Both procedures work on the same principle.