ACADEMIC AND RESEARCH PEER-REVIEWED MEDICAL JOURNALISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
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Portal Hypertension in Pediatric Patients: 28 Years of Experience in Surgical Treatment

Bibliography link: Razumovsky A. Yu., Dronov A. F., Rachkov V. E., Alkhasov A. B., Mitupov Z. B., Feoktistova E. V., Kulikova N. V., Stepanenko N. S. Portal Hypertension in Pediatric Patients: 28 Years of Experience in Surgical Treatment. Doctor.Ru. 2017; 12(141): 43–49.
14 November 00:00

Study Objective: To improve outcomes of surgical treatment in pediatric patients with portal hypertension (PH).

Study Design: This was a multipurpose cohort study.

Materials and Methods: This paper summarizes the experience of performing surgery in 789 patients with different forms of PH, aged 2.5 months to 17 years. Seven hundred and eighteen patients (91.0%) had extrahepatic portal hypertension (EPH), 66 patients (8.4%) had intrahepatic PH, and five patients (0.6%) had suprahepatic PH (Budd-Chiari syndrome).

A total of 791 surgeries were performed on 764 patients, including 27 reoperations when the first procedure was not effective. Another 25 patients are currently being followed up, and are not in danger of bleeding. In most of the patients, various portosystemic shunts were created. Twenty-four children underwent gastroesophageal devascularization (Sugiura procedure). Mesoportal bypass (MPB) was performed on 81 patients.

Study Results: In 737 patients (96.5%), the risk of bleeding from variceal veins was eliminated by the first procedure. Seven hundred and sixty-seven procedures were performed to create portosystemic shunts, including 15 reoperations. Varices size reduction was achieved in 74 (91.4%) of the patients who underwent MPB. In five patients variceal bleeding recurred in the postoperative period, and in three patients varices size was not reduced. In all cases in which MPB was not effective, another surgery was done and portosystemic shunts of various types were created. The risk of bleeding was eliminated.

Conclusion: Research has consistently shown that vascular operations are not only effective in preventing bleeding from esophageal varices, but also can often restore normal anatomical and physiological interactions in the portal venous territories. Surgical devascularization is indicated when vascular operations cannot be done.

A. Yu. Razumovsky — N. I. Pirogov Russian National Research Medical University, Moscow. N. F. Filatov City Pediatric Clinical Hospital No.13, Moscow City Department of Health. E-mail: 1595105@mail.ru

A. F. Dronov — N. I. Pirogov Russian National Research Medical University, Moscow. E-mail: vrachcov@mail.ru

V. E. Rachkov — N. I. Pirogov Russian National Research Medical University, Moscow. Lapino Clinical Hospital, OOO Khaven, Moscow. E-mail: vrachcov@mail.ru

A. B. Alkhasov — N. I. Pirogov Russian National Research Medical University, Moscow. N. F. Filatov City Pediatric Clinical Hospital No.13, Moscow City Department of Health. E-mail: 7111957@mail.ru

Z. B. Mitupov — N. I. Pirogov Russian National Research Medical University, Moscow. N. F. Filatov City Pediatric Clinical Hospital No.13, Moscow City Department of Health. E-mail: vrachcov@mail.ru

E. V. Feoktistova — N. I. Pirogov Russian National Research Medical University, Moscow. Dmitry Rogachyov National Applied Research Center for Pediatric Hematology, Oncology and Immunology, Moscow. E-mail: vrachcov@mail.ru

N. V. Kulikova — N. F. Filatov City Pediatric Clinical Hospital No.13, Moscow City Department of Health. E-mail: dr.kulikovan.v@gmail.com

N. S. Stepanenko — N. I. Pirogov Russian National Research Medical University, Moscow. E-mail: vrachcov@mail.ru


Доктор.ру
14 November 00:00
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