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Oral Presentation - 87
New approach for the surgical treatment of children with portal hypertension.
Alexander Razumovsky 1, Viktor Rachkov 2, Sergey Margaryan 1, Zorikto Mitupov 1, Alexander Zadvernyuk 1, Nadezhda Kulikova 3, Galina Chumakova 3
1 Pirogov Russian National Research Medical University, Faculty of Pediatric Surgery, Moscow, Russia
2 Pirogov Russian National Research Medical University, Moscow, Russia
3 Filatov Children's Hospital, Moscow, Russia
The effectiveness of surgical treatment of portal hypertension (PG), according to our data, reaches 97%. No less relevant is the question of the quality of the life of children in a long time after operations. Almost 35% of children with an extrahepatic form of PG is possible to perform mesortal shunting (MPS), ensuring the high quality of the child’s life. In other cases, various variants of portosystem shunting (PSS) are performed. However, catamnestic studies indicate some decrease in the portal perfusion (PP) of the liver after PSS, which can lead to a decrease in the quality of life. A new operation was proposed in our clinic - the reconstruction of the previously performed side-to-side splenorenal (SRS) to distal splenorenal shunt(DSRS) (total PSS to a selective shunt) by clipping/ligating the spleen vein .
Material and methods: SRA reconstruction surgeries have been performed since 2020. A total of 64 children have been operated on using laparotomy or laparoscopic approaches. Study of the ammonia level in the blood, angiography, and MRI of the brain have been added to the pre- and postoperative examination.
Results: Our long-term studies have shown that SRS can cause the hyperammonemia, neurological disorders in the late postoperative period due to a decrease in PPP. This situation is typical for the so-called "total portosystemic shunts".
After the use of SRS reconstruction surgery, 78% of children showed signs of improvement in PPP. A decrease in the level of ammonia in the blood was noted in 72% of children. In 43% of patients, MRI revealed the elimination of manganese salt accumulation in the brain (signs of portosystemic encephalopathy).
Conclusion. The developed operation of SRS reconstruction to DSRS, aimed at improving the PP, is a promising method for preventing hyperammonemia and neurological changes in children with PG.