WOFAPS 2025 8th World Congress of Pediatric Surgery

Melis Cevhertaş ¹, Ülgen Çeltik ¹, Mahmut Küsbeci ², Ezgi Kıran Taşcı ³, Ezgi Yavuz ³, Miray Karakoyun ³, Ahmet Çelik ¹

¹ Department of Pediatric Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
² Ege University Faculty of Medicine Department of Radiology Division of Interventional Radiology
³ Ege University Faculty of Medicine Department of Pediatric Gastroenterology

Introduction

Children with intestinal failure (IF) often need long-term total parenteral nutrition (TPN), making secure central venous access a critical component of care.However, repeated catheterizations and vascular thromboses may lead to central venous exhaustion, necessitating alternative access routes.In such cases, the transhepatic approach has emerged as an alternative.In this study, we aimed to present our experience with transhepatic port placement in children with IF at our intestinal rehabilitation center.

Methods

We retrospectively reviewed six TPN-dependent IF patients with no central venous access who underwent transhepatic port placement.All catheters were inserted percutaneously under image guidance by experienced interventional radiologists.

Results

There were six patients who required transhepatic port insertion, and their age, weight and primary diagnosis are summarized in Table 1.There were no intraoperative complications.In postoperative period, all transhepatic ports required revision.Five catheters were spontaneously dislocated, and one required revision due to poor skin site condition.The timing of dislocation for each case is presented in Table 1.One patient died following port dislodgement, which resulted in TPN leakage into the peritoneal cavity.In four of the remaining five patients, intracardiac port placement was performed, while in one patient, access was achieved via puncture of the inferior vena cava.

Conclusion

Transhepatic port placement via hepatic vein puncture can be performed safely without intraoperative complications.However, diaphragmatic motion appears to contribute to a high rate of catheter dislodgement, limiting the long-term reliability of this approach in children with IF.