Portal decompression in infants and children with the interposition mesocaval shunt

There are special considerations in planning the surgical management of infants and children with portal hypertension. Elevated portal pressure is frequently a manifestation of extrahepatic obstruction to portal venous flow [I]. Therefore, in contrast to the majority of adult patients with clinically significant portal hypertension who have underlying liver disease, many children have functionally intact livers. Recent progress in the surgical management of infants with extrahepatic biliary atresia has produced a unique group of infants and young children with portal hypertension. In many, adequate bile flow is established, growth and development are satisfactory, and liver function is normal or nearly normal despite a progression of hepatic fibrosis [2-41. Gastrointestinal bleeding from esophageal varices poses the most serious threat to life. Because of the diminutive size of the vessels available for shunting and the inadvisability of sacrificing the spleen in a child, operative procedures for portal decompression used in adults are often unsatisfactory in children. Furthermore, the portal vein is likely to be unsuitable for shunting because of anatomic abnormalities ‘or inaccessibility due to previous surgery in the portahepatis. In these infants and children, we have successfully utilized the interposition mesocaval shunt to decompress the portal system.