Distal spleno-renal shunt for portal decompression in childhood.

Successful portal decompression presents a unique challenge in children. The meso-caval shunt, utilizing the large caliber iliac vein in constructing the anastomosis, has been accepted as the standard operative procedure for treating these patients. Technical and anatomic difficulties, however, often prevent the successful performance of this shunt. The proximal spleno-renal shunt, advocated by many as an alternative in children, incurs the penalty of splenectomy. Furthermore, in both techniques, portal venous blood is preferentially shunted from the liver, posing a potential for subsequent development of hepatic encephalopathy as the patients mature. The distal spleno-renal shunt avoids these problems by selectively decompressing the esophageal venous plexus through the spleen. With this procedure, the majority of portal venous blood flow is maintained and the spleen is preserved. The present report describes three children in whom the distal spleno-renal shunt has been successfully employed for portal decompression. The youngest of these patients was 2 1/2 yr of age at the time of operation and has a patent portal-systemic shunt 18 mo postoperatively. This experience confirms the effectiveness of the distal spleno-renal shunt as an alternative to the meso-caval shunt, especially in children with inflammatory involvement of the superior mesenteric vein.