WOFAPS 2025 8th World Congress of Pediatric Surgery

Kaushal Kulkarni, Pooja Prajapati, Rohit Meshram, Vijai Datta Upadhyaya

SGPGIMS, Lucknow India

Introduction:

Extrahepatic portal vein obstruction (EHPVO) is the commonest cause of portal hypertension presenting with gastrointestinal bleeding and splenomegaly in India. Endotherapy is the mainstay of treatment for acute variceal bleed control and has also been used extensively for secondary prophylaxis till variceal eradication is achieved. More than one major bleeding episode, hypersplenism, splenomegaly, presence of fundal varices, growth retardation, portal biliopathy are the main indications for shunt surgery.

Materials and Methods:

Patients under the age of 18 years operated for EHPVO who underwent side-to-side leno-renal shunt in the past 2 years were included in this study.

Results:

9 patients of EHPVO with age range of 2 – 18 years were managed at our centre in whom Mitra shunt done. The patients were evaluated with an ultrasound doppler of the hepato-biliary and portal system and with a CT Portogram for assessing anatomy. The splenic size was 10.5 to 16 cm (mean 13.4cm), splenic vein measured 4 – 9mm (mean 6.6mm) and left renal vein 4 – 12 mm (mean 7.1mm). A side-to-side leno-renal (Mitra) shunt was performed in all case of size range 8-15mm (mean – 11.6). The shunt was patent in all case at the time of discharge and follow up at 1 and 3 months.

Conclusion:

Leno-renal shunt surgery is an essential modality in the treatment of EHPVO. Side-to-side (Mitra) shunts is an ideal option for the surgical management of symptomatic portal hypertension in patients with small diameter splenic vein.