Portosystemic shunting in children during the era of endoscopic therapy: Improved postoperative growth parameters

Tomoaki Kato, Rene Romero, Raghad Koutouby, Naveen K. Mittal, John F. Thompson, Charles L. Schleien, Andreas G. Tzakis

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Background: Surgical portosystemic shunting has been performed less frequently in recent years. In this retrospective study, recent outcomes of portosystemic shunting in children are described, to evaluate its role in the era of endoscopic therapy. Methods: Retrospective chart review of children who underwent surgical portosystemic shunt procedures between October 1994 and October 1997. Results: Twelve children (age range, 1-16 years) underwent shunting procedures. The causes of portal hypertension were extrahepatic portal vein thrombosis (n = 6), congenital hepatic fibrosis (n = 2), hepatic cirrhosis (n = 2), and other (n = 2). None of the patients were immediate candidates for liver transplantation. Types of shunt included: distal splenorenal (n = 10), portocaval (n = 1), and other (n = 1). Median follow-up was 35 months (range, 24-48 months). All patients are currently alive and well with patent shunts. The mean hospital stay was 8 days. Three patients required readmission for further interventions because of shunt stenosis in two and small bowel obstruction in the other. Mild portosystemic encephalopathy was seen in one child with pre-existing neurobehavioral disturbance. Excluding a patient who underwent placement of a portosystemic shunt for a complication of liver transplantation, mean weight-for-age z score in nine prepubertal patients improved from -1.16 SD to +0.15 SD (P = 0.023), and mean height-for-age z score from -1.23 SD to 0.00 SD (P = 0.048) by 2 years after surgery. Conclusions: Surgical portosystemic shunting is a safe and effective method for the management of portal hypertension in childhood. Patients show significant improvements in growth parameters after the procedure. Surgical portosystemic shunting should be actively considered in selected children with portal hypertension. (C) 2000 Lippincott Williams and Wilkins, Inc.

Original languageEnglish (US)
Pages (from-to)419-425
Number of pages7
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume30
Issue number4
DOIs
StatePublished - Apr 2000
Externally publishedYes

Fingerprint

portal hypertension
Portal Hypertension
therapeutics
Surgical Portasystemic Shunt
Growth
liver transplant
liver cirrhosis
Liver Transplantation
Therapeutics
Patient Readmission
Hepatic Encephalopathy
Portal Vein
encephalopathy
portal vein
Liver Cirrhosis
thrombosis
patents
Length of Stay
Pathologic Constriction
retrospective studies

Keywords

  • Child
  • Growth
  • Hypertension
  • Portal
  • Portosystemic Shunt
  • Surgery

ASJC Scopus subject areas

  • Gastroenterology
  • Histology
  • Medicine (miscellaneous)
  • Food Science
  • Pediatrics, Perinatology, and Child Health

Cite this

Portosystemic shunting in children during the era of endoscopic therapy : Improved postoperative growth parameters. / Kato, Tomoaki; Romero, Rene; Koutouby, Raghad; Mittal, Naveen K.; Thompson, John F.; Schleien, Charles L.; Tzakis, Andreas G.

In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 30, No. 4, 04.2000, p. 419-425.

Research output: Contribution to journalArticle

Kato, Tomoaki ; Romero, Rene ; Koutouby, Raghad ; Mittal, Naveen K. ; Thompson, John F. ; Schleien, Charles L. ; Tzakis, Andreas G. / Portosystemic shunting in children during the era of endoscopic therapy : Improved postoperative growth parameters. In: Journal of Pediatric Gastroenterology and Nutrition. 2000 ; Vol. 30, No. 4. pp. 419-425.
@article{5e7c3da819154b7d985d7fdf56a2a6c0,
title = "Portosystemic shunting in children during the era of endoscopic therapy: Improved postoperative growth parameters",
abstract = "Background: Surgical portosystemic shunting has been performed less frequently in recent years. In this retrospective study, recent outcomes of portosystemic shunting in children are described, to evaluate its role in the era of endoscopic therapy. Methods: Retrospective chart review of children who underwent surgical portosystemic shunt procedures between October 1994 and October 1997. Results: Twelve children (age range, 1-16 years) underwent shunting procedures. The causes of portal hypertension were extrahepatic portal vein thrombosis (n = 6), congenital hepatic fibrosis (n = 2), hepatic cirrhosis (n = 2), and other (n = 2). None of the patients were immediate candidates for liver transplantation. Types of shunt included: distal splenorenal (n = 10), portocaval (n = 1), and other (n = 1). Median follow-up was 35 months (range, 24-48 months). All patients are currently alive and well with patent shunts. The mean hospital stay was 8 days. Three patients required readmission for further interventions because of shunt stenosis in two and small bowel obstruction in the other. Mild portosystemic encephalopathy was seen in one child with pre-existing neurobehavioral disturbance. Excluding a patient who underwent placement of a portosystemic shunt for a complication of liver transplantation, mean weight-for-age z score in nine prepubertal patients improved from -1.16 SD to +0.15 SD (P = 0.023), and mean height-for-age z score from -1.23 SD to 0.00 SD (P = 0.048) by 2 years after surgery. Conclusions: Surgical portosystemic shunting is a safe and effective method for the management of portal hypertension in childhood. Patients show significant improvements in growth parameters after the procedure. Surgical portosystemic shunting should be actively considered in selected children with portal hypertension. (C) 2000 Lippincott Williams and Wilkins, Inc.",
keywords = "Child, Growth, Hypertension, Portal, Portosystemic Shunt, Surgery",
author = "Tomoaki Kato and Rene Romero and Raghad Koutouby and Mittal, {Naveen K.} and Thompson, {John F.} and Schleien, {Charles L.} and Tzakis, {Andreas G.}",
year = "2000",
month = "4",
doi = "10.1097/00005176-200004000-00013",
language = "English (US)",
volume = "30",
pages = "419--425",
journal = "Journal of Pediatric Gastroenterology and Nutrition",
issn = "0277-2116",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Portosystemic shunting in children during the era of endoscopic therapy

T2 - Improved postoperative growth parameters

AU - Kato, Tomoaki

AU - Romero, Rene

AU - Koutouby, Raghad

AU - Mittal, Naveen K.

AU - Thompson, John F.

AU - Schleien, Charles L.

AU - Tzakis, Andreas G.

PY - 2000/4

Y1 - 2000/4

N2 - Background: Surgical portosystemic shunting has been performed less frequently in recent years. In this retrospective study, recent outcomes of portosystemic shunting in children are described, to evaluate its role in the era of endoscopic therapy. Methods: Retrospective chart review of children who underwent surgical portosystemic shunt procedures between October 1994 and October 1997. Results: Twelve children (age range, 1-16 years) underwent shunting procedures. The causes of portal hypertension were extrahepatic portal vein thrombosis (n = 6), congenital hepatic fibrosis (n = 2), hepatic cirrhosis (n = 2), and other (n = 2). None of the patients were immediate candidates for liver transplantation. Types of shunt included: distal splenorenal (n = 10), portocaval (n = 1), and other (n = 1). Median follow-up was 35 months (range, 24-48 months). All patients are currently alive and well with patent shunts. The mean hospital stay was 8 days. Three patients required readmission for further interventions because of shunt stenosis in two and small bowel obstruction in the other. Mild portosystemic encephalopathy was seen in one child with pre-existing neurobehavioral disturbance. Excluding a patient who underwent placement of a portosystemic shunt for a complication of liver transplantation, mean weight-for-age z score in nine prepubertal patients improved from -1.16 SD to +0.15 SD (P = 0.023), and mean height-for-age z score from -1.23 SD to 0.00 SD (P = 0.048) by 2 years after surgery. Conclusions: Surgical portosystemic shunting is a safe and effective method for the management of portal hypertension in childhood. Patients show significant improvements in growth parameters after the procedure. Surgical portosystemic shunting should be actively considered in selected children with portal hypertension. (C) 2000 Lippincott Williams and Wilkins, Inc.

AB - Background: Surgical portosystemic shunting has been performed less frequently in recent years. In this retrospective study, recent outcomes of portosystemic shunting in children are described, to evaluate its role in the era of endoscopic therapy. Methods: Retrospective chart review of children who underwent surgical portosystemic shunt procedures between October 1994 and October 1997. Results: Twelve children (age range, 1-16 years) underwent shunting procedures. The causes of portal hypertension were extrahepatic portal vein thrombosis (n = 6), congenital hepatic fibrosis (n = 2), hepatic cirrhosis (n = 2), and other (n = 2). None of the patients were immediate candidates for liver transplantation. Types of shunt included: distal splenorenal (n = 10), portocaval (n = 1), and other (n = 1). Median follow-up was 35 months (range, 24-48 months). All patients are currently alive and well with patent shunts. The mean hospital stay was 8 days. Three patients required readmission for further interventions because of shunt stenosis in two and small bowel obstruction in the other. Mild portosystemic encephalopathy was seen in one child with pre-existing neurobehavioral disturbance. Excluding a patient who underwent placement of a portosystemic shunt for a complication of liver transplantation, mean weight-for-age z score in nine prepubertal patients improved from -1.16 SD to +0.15 SD (P = 0.023), and mean height-for-age z score from -1.23 SD to 0.00 SD (P = 0.048) by 2 years after surgery. Conclusions: Surgical portosystemic shunting is a safe and effective method for the management of portal hypertension in childhood. Patients show significant improvements in growth parameters after the procedure. Surgical portosystemic shunting should be actively considered in selected children with portal hypertension. (C) 2000 Lippincott Williams and Wilkins, Inc.

KW - Child

KW - Growth

KW - Hypertension

KW - Portal

KW - Portosystemic Shunt

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=0034039530&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034039530&partnerID=8YFLogxK

U2 - 10.1097/00005176-200004000-00013

DO - 10.1097/00005176-200004000-00013

M3 - Article

C2 - 10776954

AN - SCOPUS:0034039530

VL - 30

SP - 419

EP - 425

JO - Journal of Pediatric Gastroenterology and Nutrition

JF - Journal of Pediatric Gastroenterology and Nutrition

SN - 0277-2116

IS - 4

ER -