Long-term results following surgical management of portal hypertension in children.

The article reports on 261 children with extrahepatic portal hypertension on whom surgery for control of variceal bleeding was performed. In 96 patients direct shunt operations and in 151 children shunt operations were effected. Cavo-mesenteric shunts ensure best permanent relief from variceal bleeding due to extrahepatic block to the extent of 80% in children with mesenteric veins suitable for shunting. Side-to-side spleno-renal shunts and interposition of H-grafts using the autologous jugular vein had a low incidence of thrombosis and rebleeding in the few patients in whom they were applied. The centro-splenorenal shunt with 47% incidence of rebleeding is now believed to be a second-choice operation. Direct operations to control haemorrhage from PVT are performed if no suitable veins for shunting are available. Partial oesophago-gastrectomy with colon interposition as well as portal azygos disconnection and oesophageal or gastric transection yield the best results.