Vascular bypass surgery in the treatment of extrahepatic portal hypertension in children (review)

Abstract

In children with extrahepatic portal hypertension (HSV), the most frequent and life-threatening complication is bleeding from varicose veins of the esophagus and stomach. Therefore, the main task of HSV treatment is to prevent bleeding from the veins of the upper gastrointestinal tract. The most effective treatment is portosystem bypass surgery (PSS), the effectiveness of which reaches 94-97%. However, the use of these operations is limited precisely because of a decrease in portal liver perfusion (PPP) and the development of portosystemic encephalopathy (PSE). The aim is to analyze domestic and foreign publications devoted to the surgical treatment of portal hypertension and the development of portosystemic encephalopathy in the postoperative period. A systematic search was carried out in the databases PubMed, Web of Science, Scopus, MEDLINE, eLibrary, RSCI, Cyberleninka. 345 references were analyzed, 110 articles were reviewed, 97 publications on surgical treatment of portal hypertension were selected for the review. The development of PSE in the postoperative period often occurs after the imposition of total PSS. To reduce the risk of developing PSE, selective shunts have been developed, which to some extent preserve the PPP. With distal splenorenal anastomosis (DSRA), the frequency of PE is less than 10-15%. An intermediate position is occupied by a side-to-side splenorenal anastomosis, which has signs of selective surgery. The results of the analysis of literature sources showed that discussions are still underway regarding the choice of the optimal treatment strategy for patients with HSV, the place and role of endoscopic methods for the prevention of gastrointestinal bleeding, as well as mesoportal shunt (MPSH) in the treatment of patients with extrahepatic PG. Nevertheless, the majority of world experts consider MPSH to be the most optimal operation for primary and secondary prevention of varicose bleeding and other complications of HSV. And if it is impossible to perform it, the operation of selective bypass surgery of the DSRA can serve as an alternative to performing MPSH.