Warren shunt combined with partial splenectomy in children with extra-hepatic portal hypertension, massive splenomegaly and severe hypersplenism
Introduction. Extra-hepatic portal vein obstruction (EHPVO) is one of the most often causes of portal hypertension in children. Objective. Establishing the importance of shunt surgery in combination with partial spleen resection in selected pediatric patients with EHPVO, enormous splenomega...
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| Format: | Article |
| Language: | English |
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Serbian Medical Society
2014-01-01
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| Series: | Srpski Arhiv za Celokupno Lekarstvo |
| Subjects: | |
| Online Access: | http://www.doiserbia.nb.rs/img/doi/0370-8179/2014/0370-81791408419S.pdf |
| _version_ | 1818615391779291136 |
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| author | Sretenović Aleksandar Perišić Vojislav Vujović Dragana Opačić Dragan Vukadinović Vojkan Pavićević Polina Radević Božina |
| author_facet | Sretenović Aleksandar Perišić Vojislav Vujović Dragana Opačić Dragan Vukadinović Vojkan Pavićević Polina Radević Božina |
| author_sort | Sretenović Aleksandar |
| collection | DOAJ |
| description | Introduction. Extra-hepatic portal vein obstruction (EHPVO) is one of the
most often causes of portal hypertension in children. Objective. Establishing
the importance of shunt surgery in combination with partial spleen resection
in selected pediatric patients with EHPVO, enormous splenomegaly and severe
hypersplenism. Methods. Distal splenorenal shunt (DSRS) with partial spleen
resection was performed in 22 children age from 2 to 17 years with EHPVO.
Indications for surgery were pain and abdominal discomfort caused by spleen
enlargement, as well as symptomatic hypersplenism with leucopenia,
thrombocytopenia and anemia. The partial spleen resection was performed by
ligation of blood vessels to caudal two thirds of the spleen. After ischemic
parenchymal demarcation transection with electrocautery LigaSure was
performed with preservation of 20-30% of spleen tissue, and then Warren DSRS
was created. Platelet and leucocytes counts and liver function tests were
obtained before, one month and one year after surgery. Growth was assessed
with SD scores (Z scores) for height, weight and body mass index at the time
of surgery and one year later. Results. In all patients postoperative period
was without significant complications. Platelets and leucocytes counts were
normalized. Patency rate of shunts was 100%. Two significant shunts stenosis
were observed and successfully treated with percutaneous angioplasty. During
the follow-up period (1 to 9 years) all patients were asymptomatic, with
improved quality of life and growth. Conclusion. Results of our study
indicate that shunt surgery with a partial spleen resection is an effective
and safe procedure for patients with enormous splenomegaly and severe
hypersplenism caused by EHPVO. |
| first_indexed | 2024-12-16T16:33:10Z |
| format | Article |
| id | doaj.art-6871cdfd686842d8b10b2b0daf950251 |
| institution | Directory Open Access Journal |
| issn | 0370-8179 |
| language | English |
| last_indexed | 2024-12-16T16:33:10Z |
| publishDate | 2014-01-01 |
| publisher | Serbian Medical Society |
| record_format | Article |
| series | Srpski Arhiv za Celokupno Lekarstvo |
| spelling | doaj.art-6871cdfd686842d8b10b2b0daf9502512022-12-21T22:24:32ZengSerbian Medical SocietySrpski Arhiv za Celokupno Lekarstvo0370-81792014-01-011427-841942310.2298/SARH1408419S0370-81791408419SWarren shunt combined with partial splenectomy in children with extra-hepatic portal hypertension, massive splenomegaly and severe hypersplenismSretenović Aleksandar0Perišić Vojislav1Vujović Dragana2Opačić Dragan3Vukadinović Vojkan4Pavićević Polina5Radević Božina6School of Medicine, Belgrade + University Children’s Hospital, BelgradeSchool of Medicine, Belgrade + University Children’s Hospital, BelgradeUniversity Children’s Hospital, BelgradeUniversity Children’s Hospital, BelgradeSchool of Medicine, Belgrade + University Children’s Hospital, BelgradeUniversity Children’s Hospital, BelgradeUniversity Children’s Hospital, BelgradeIntroduction. Extra-hepatic portal vein obstruction (EHPVO) is one of the most often causes of portal hypertension in children. Objective. Establishing the importance of shunt surgery in combination with partial spleen resection in selected pediatric patients with EHPVO, enormous splenomegaly and severe hypersplenism. Methods. Distal splenorenal shunt (DSRS) with partial spleen resection was performed in 22 children age from 2 to 17 years with EHPVO. Indications for surgery were pain and abdominal discomfort caused by spleen enlargement, as well as symptomatic hypersplenism with leucopenia, thrombocytopenia and anemia. The partial spleen resection was performed by ligation of blood vessels to caudal two thirds of the spleen. After ischemic parenchymal demarcation transection with electrocautery LigaSure was performed with preservation of 20-30% of spleen tissue, and then Warren DSRS was created. Platelet and leucocytes counts and liver function tests were obtained before, one month and one year after surgery. Growth was assessed with SD scores (Z scores) for height, weight and body mass index at the time of surgery and one year later. Results. In all patients postoperative period was without significant complications. Platelets and leucocytes counts were normalized. Patency rate of shunts was 100%. Two significant shunts stenosis were observed and successfully treated with percutaneous angioplasty. During the follow-up period (1 to 9 years) all patients were asymptomatic, with improved quality of life and growth. Conclusion. Results of our study indicate that shunt surgery with a partial spleen resection is an effective and safe procedure for patients with enormous splenomegaly and severe hypersplenism caused by EHPVO.http://www.doiserbia.nb.rs/img/doi/0370-8179/2014/0370-81791408419S.pdfportal hypertensionsplenomegalyhypersplenismpartial splenectomyWarren shunt |
| spellingShingle | Sretenović Aleksandar Perišić Vojislav Vujović Dragana Opačić Dragan Vukadinović Vojkan Pavićević Polina Radević Božina Warren shunt combined with partial splenectomy in children with extra-hepatic portal hypertension, massive splenomegaly and severe hypersplenism Srpski Arhiv za Celokupno Lekarstvo portal hypertension splenomegaly hypersplenism partial splenectomy Warren shunt |
| title | Warren shunt combined with partial splenectomy in children with extra-hepatic portal hypertension, massive splenomegaly and severe hypersplenism |
| title_full | Warren shunt combined with partial splenectomy in children with extra-hepatic portal hypertension, massive splenomegaly and severe hypersplenism |
| title_fullStr | Warren shunt combined with partial splenectomy in children with extra-hepatic portal hypertension, massive splenomegaly and severe hypersplenism |
| title_full_unstemmed | Warren shunt combined with partial splenectomy in children with extra-hepatic portal hypertension, massive splenomegaly and severe hypersplenism |
| title_short | Warren shunt combined with partial splenectomy in children with extra-hepatic portal hypertension, massive splenomegaly and severe hypersplenism |
| title_sort | warren shunt combined with partial splenectomy in children with extra hepatic portal hypertension massive splenomegaly and severe hypersplenism |
| topic | portal hypertension splenomegaly hypersplenism partial splenectomy Warren shunt |
| url | http://www.doiserbia.nb.rs/img/doi/0370-8179/2014/0370-81791408419S.pdf |
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