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Outcome of portosystemic shunt surgery on pre‐existing cholangiopathy in children with extrahepatic portal vein obstruction
Author(s) -
Ravindranath Aathira,
Sen Sarma Moinak,
Yachha Surender Kumar,
Lal Richa,
Singh Somesh,
Srivastava Anshu,
Poddar Ujjal,
Neyaz Zafar,
Behari Anu
Publication year - 2020
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.692
Subject(s) - medicine , shunt (medical) , radiology , portal hypertension , magnetic resonance imaging , surgery , portosystemic shunt , esophageal varices , varices , splenectomy , gastroenterology , cirrhosis , spleen
Background This study was performed to assess the effect of portosystemic shunt surgery (PSS) on portal cavernoma cholangiopathy (PCC) in children with extrahepatic portal vein obstruction (EHPVO). Methods Children with EHPVO and PCC (unfit for Meso‐Rex shunt) underwent magnetic resonance cholangiogram (MRC) and magnetic resonance portovenogram (MRPV) before non‐selective PSS. PCC was graded by modified Llop classification. Those with patent shunt were re‐evaluated at least 6 months after surgery with MRC, MRPV and compared with pre‐shunt images. Results Twenty‐five children underwent PSS (central end to side splenorenal shunt with splenectomy [ n = 24], mesocaval shunt [ n = 1]). Pre‐surgery MRC showed PCC grade I in 11, grade II in 1 and grade III in 13. MRPV showed superior mesenteric vein (SMV) block in 20. Re‐assessment for PCC 18 (6 to 54) months after surgery showed grade I in 6 and grade III in 19. Thus, PCC was progressive in 6 and static in 19. Density of peribiliary collaterals decreased in 5 (SMV patent, static PCC), increased in 3 and remained unchanged in 17. Splenomegaly‐related problems, gastroesophageal varices and other intra‐abdominal (esophageal, perisplenic and perigastric) collaterals ameliorated in all. Conclusion Non‐selective PSS decompresses esophago‐gastro‐splenic venous circuit effectively but fails to ameliorate cholangiopathy and peribiliary collaterals. Persistence of cholangiopathy is attributable to SMV block.