PORTOSYSTEMIC SHUNT SURGERY IN A LIMITED FACILITY SETUP: CHALLENGES AND OUTCOMES

Abstract

Background:Extrahepatic portal venous obstruction (EHPVO) is the most common cause of paediatric portal hypertension. Cases come from remote background with limited access to health and need proper addressal. We analysed the challenges and outcomes of Porto systemic shunts in a limited facility setup.

Study design: Prospective study

Methods: 29 consecutive children below 18 years operated with a diagnosis of EHPVO formed the study group. All were operated on the basis of clinical findings, presence of hypersplenism and documented portal vein thrombosis on Doppler ultrasound. Results with respect to shunt patency and rebleed were collected. Problem encountered with respect to assistance, blood loss, operating time, vascular anastomosis were recorded based on indigenous scoring system for self-audit.

Results: 29 cases formed the study group andproximal lienorenal shunt (LRS) was performed in 19 cases because of massive splenomegaly with infarcts. Splenectomy with devascularisation was performed in remaining 10 cases. Follow-up ranged from 3 to 12 months. All the cases except one had a patent shunt at last follow up. Mean operating time was 4.30 hours (Range 4.00- 6.00 hours). All the cases were done under 2.5 magnification using instruments from the general surgery department with custom made needle tip cautery as the only energy device. All the cases were kept nil by mouth for 24 hours and discharged at a mean duration of 5 days (Range 4-6 days).

Conclusions: Porto systemic Shunt in children with EHPVO is a viable option. This can be performed even in limited facilities with minimal assistance.