[Portal hypertension and bleeding esophageal varices in children. Esophageal transection with paraesophagogastric devascularization versus shunting procedures (author's transl)].

It is known that portasystemic shunts in the treatment of portal hypertension causes in the long term a high rate of complications in children. The most severe are encephalopathy, postoperative hepatic failure in intrahepatic hypertension and occlusion or poor functioning of the shunts. The incidence of the last mentioned complication is high in children, especially in those operated in their early years of life. The most severe danger of portal hypertension is the haemorrhage from bleeding esophageal varices. During the last few years the technique of esophagogastric devascularization with esophageal transection and ligation of varices (Sugiura's procedure) has given a very high percentage of success in the long term. The Authors report their experience with Sugiura's procedure in 9 children with portal hypertension (average age at operation of four and half years). In six cases there was a prehepatic and in the other three an intrahepatic hypertension. The follow-up varied from six months to seven and half years with an average of almost four years. In all the children the surgical treatment was successful with the complete disappearance of haemorrhage and esophageal varices. For their own experience and for Sugiura's long-term results, the Authors think that Sugiura's procedure offers the most effective alternative to portasystemic shunts in the surgical treatment of portal hypertension, especially in early childhood.