Akademik Veri Yönetim Sistemi
Pediatrik Cerrahi Dergisi, cilt.17, sa.3, ss.106-114, 2003 (Scopus)
Aim: Endoscopic sclerotherapy and porto-systemic shunt operations are performed for the prevention of variceal hemorrhage due to extrahepatic portal vein thrombosis (EHPVT). After introduction of mesenterico-left portal bypass procedure (MLPB), the question whether prophylactic measures should be used for EHPVT or definitive treatment (MLPB) should be performed became evident. We herein present our experience with MLPB in children with EHPVT. Method: Eight patients treated for EHPVT (4 boys, 4 girls) were evaluated. While seven patients presented with recurrent variceal hemorrhage, one had only splenomegaly. All patients underwent Doppler US examination, needle liver biopsy and upper GI endoscopy. Seven patients treated with endoscopic sclerotherapy rebled despite repeated sclerotherapies thus underwent MLPB operation. Results: Seven patients presented with variceal hemorrhage and hypersplenizm. One patient presented with splenomegaly only. In 6 patients among the 7 a MLPB procedure was performed, while one patient died from variceal hemorrhage. Left portal veins were patent in four patients and MLPB procedure was performed. Left portal veins of the remaining two patients were found to be obliterated therefore meso-caval shunt was performed. Upper GI bleeding occurred in the early postoperative period in one patient with MLPB procedure due to a prepyloric ulcer that was successfully treated by endoscopic sclerotherapy. None of patients with MLPB procedure experienced variceal rebleeding and control endoscopies showed reduction in esophageal varices. Conclusion: Endoscopic sclerotherapy and porto-systemic shunt procedures are intended for prophylaxis of the variceal bleeding due to EHPVT. MLPB procedure is the curative definitive treatment for the children with EHPVT.