WOFAPS 2025 8th World Congress of Pediatric Surgery

omar khamag, Thozama Siyotula

Division of Pediatric surgery, University of Cape Town (UCT); Red Cross War Memorial Children’s hospital

Introduction

Extrahepatic portal vein thrombosis (EHPVT) is a major cause of paediatric non-cirrhotic

portal hypertension, leading to recurrent variceal bleeding. The distal splenorenal shunt

(DSRS) is a well-established surgical approach; however, it does not effectively decompress

all gastroesophageal varices, particularly those draining via the left gastric vein (LGV).

Persistent varices often lead to continued bleeding despite a patent shunt, necessitating an

alternative surgical strategy.

Aim & Objective

We describe a novel dual-shunt technique, integrating DSRS with a left gastric vein-to-left

renal vein (LGV-LRV) shunt, to achieve comprehensive decompression of gastroesophageal

varices. This approach was applied in a 3-year-old child (10 kg) with EHPVT, who presented

with life-threatening variceal bleeding refractory to endoscopic treatment.

Methods

The procedure involved:

1. DSRS: Splenic vein-to-left renal vein anastomosis, reducing portal pressure from 23

mmHg to 12 mmHg intraoperatively.

2. LGV-LRV Shunt: Novel redirection of LGV drainage to the left renal vein, addressing

residual esophageal varices.

Results

Postoperative Doppler ultrasound confirmed shunt patency, and the patient remained

bleeding-free at follow-up. This technique eliminated persistent varices, demonstrating

effective dual pathway decompression.

Conclusion

This is the first reported case of an LGV-LRV shunt, offering a paradigm shift in paediatric

portal hypertension surgery. The technique enhances hemodynamic control, warrants further

investigation, and could be a new standard for refractory cases.