[Experience with mesocaval shunt with jugular vein interposition for treatment of portal hypertension in children (author's transl)]

Abstract

From 1979 until 1981, 10 children aged 2 and a half to 15 years, were treated by mesocaval shunt with jugular vein interposition. In 6 cases, there were liver alterations in relation to Budd-Chiari's syndrome or cirrhosis, but the splenomesenterico-portal axis was uninvolved by thrombosis; in the other 4 cases, without any liver damage except fibrosis in one case, there was extensive thrombosis of the portal system. Thus the jugular graft may be simply set between the superior mesenteric vein and the vena cava, or may have to be anastomosed in an atypical position, between a pancreatic, jejunal, ileal vein and the renal vein or the vena cava. The right jugular vein is the longest and will be more suitable; it should be removed from a point situated above the opening of the facial tributary, so that the length of the graft would be approximately 7 cm. The anastomosis itself is rather a simple procedure if one takes care to mobilize the last segments of the duodenum and the pancreas. Mean fall in portal pressure of 10 mm Hg and a mean gradient of 3 mm Hg after completion of the anastomosis were demonstrated in most cases. Flow measures through the graft done in 8 cases gave a mean result of 800 ml per mn. Postoperative controls by means of ultrasonogram and angiography in all patients except the two most recent ones showed a patent anastomosis. But the longest follow-up is only 2 and a half years, and long term results are yet to be determined, especially in regards to the risk of late encephalopathy in cases with cirrhosis.