Surgical management of portal hypertension in childhood: long-term results.

This retrospective clinical review of reports by several authors of 253 children with extrahepatic (EPH) and 87 children with intrahepatic (IPH) portal hypertension who have undergone operations for variceal hemorrhage presents the long-term follow-up based on the type of management provided. Shunt operations are preferred over direct operative procedures in patients with EPH when mesenteric veins suitable for shunting are available. Cavomesenteric shunts provide the best permanent relief from variceal bleeding. Partial esophagogastrectomy with colon interposition or poral-azygous disconnection are the best operations when a shunt is not technically feasible, almost half of the patients obtaining long-term relief from bleeding. More than one fourth of the children with EPH can be managed successfully for long periods nonoperatively. For children with variceal bleeding due to IPH, the underlying liver disease determines the prognosis. The ultimate mortality is approximately the same regardless of whether a shunt or direct procedure is performed.