[Surgical treatment of portal hypertension in children. Retrospective study of 157 cases (author's transl)].

From 1959 until 1981, 157 children were treated for portal hypertension by esophageal varices ligation in 13 cases and by portosystemic shunt in 144 cases. The age of the patients at operation was correlated with the cause of portal hypertension : mean age was six and a half years for cases with extra-hepatic blockage, and ten years for cases with cirrhosis. In 73% of cases, the shunt was undertaken following a bleeding episode from esophageal varices; at the present time, the decision to undertake a prophylactic type of shunt would be much more questionable. Central splenorenal shunt and mesocaval shunt were the operations most frequently performed by the different surgical teams in charge of these children (respectively 69 and 47 cases). Among the postoperative complications, three cases of venous stasis in lower limbs occurred after a mesocaval shunt; one child died two and a half years after a central splenorenal shunt from pneumococcal sepsis. During the last two years, there is a tendency in our group to perform a Warren shunt for intrahepatic portal hypertension, and a mesocaval shunt with jugular vein interposition in the case of extrahepatic portal hypertension. Recurrence of bleeding from esophageal varices after simple ligation has been observed in 64% of the cases; after portosystemic shunts, the anastomosis was a success in 89.3% of the cases. Whereas a significant fall in portal pressure after completion of the anastomosis is of good prognostic value, the fact that in some cases intraoperative measurement of pressure before and after shunting may show no difference does not imply a secondary thrombosis of the anastomosis, since this complication was seen in only 13% of the cases in these conditions.