Non-conventional portosystemic shunts in children with extrahepatic portal vein obstruction.

Portal hypertension due to extrahepatic portal vein obstruction is ideally treated by the use of a selective shunt. In a four year period between July 1987 and June 1992, 50 surgical procedures were carried out in 48 children with portal hypertension-related variceal hemorrhage. The portal, splenic, mesenteric, or coronary vein was not available for anastomosis in four children who, therefore, underwent non-conventional shunts which are described here. There was no postoperative mortality. One patient had a repeat gastrointestinal hemorrhage, probably due to stenosis of the shunt and failure to ligate the coronary vein. No rebleeding occurred on follow-up of at least 18 months. We conclude that in selected children requiring surgery for portal hypertension due to extrahepatic portal venous obstruction, a non-conventional shunt may be used with beneficial results.