Reconstruction of total portosystemic shunt into selective portosystemic shunt in a child

• Published in: Hirurgija (Moskva) no. 12; p. 140
• Main Authors: Margaryan, S R, Razumovsky, A Yu, Mitupov, Z B, Gurevich, A I, Titova, E A
• Format: Journal Article
• Language: Russian
• Published: Russia (Federation) 2023
• Subjects: Child; Female; Hepatic Encephalopathy - diagnosis; Hepatic Encephalopathy - etiology; Hepatic Encephalopathy - prevention & control; Humans; Hypertension, Portal - diagnosis; Hypertension, Portal - etiology; Hypertension, Portal - surgery; Portal Vein - diagnostic imaging; Portal Vein - surgery; Portasystemic Shunt, Transjugular Intrahepatic - adverse effects; Splenorenal Shunt, Surgical - adverse effects; portal liver perfusion; liver failure; portal hypertension; selective portosystemic shunt; children; hepatic encephalopathy; hyperammonemia; splenic vein occlusion; total portosystemic shunts; reconstruction of shunts
• ISSN: 0023-1207
• DOI: 10.17116/hirurgia2023121140

To date, side-to-side splenorenal shunt (SRS) and its analogues (splenosuprarenal shunts (SSRS)) are mainly used for portal hypertension. These are total portosystemic shunts characterized by total blood shunt from portal vein into inferior vena cava. The latter is fraught with a significant risk of complications such as pulmonary hypertension, decreased portal liver perfusion, liver failure and hepatic encephalopathy. Prevention of these complications is still an urgent problem in modern surgery. However, we proposed a new method of treatment, i.e. reconstruction of SRS and SSRS into selective shunt. This procedure was performed in 37 patients after 2020. We present laparoscopic reconstruction in an 11-year-old girl with portal hypertension and signs of hepatic encephalopathy identified after previous SSRS.