Treatment of extrahepatic portal hypertension in children by mesenteric-to-left portal vein bypass: a new physiological procedure.

Objective: To achieve hepatic portal revascularisation and decompression of extrahepatic portal hypertension in children with cavernoma and obstruction caused by idiopathic portal vein thrombosis.

Design: Selected cases.

Setting: Teaching hospitals. Belgium and Italy.

Subjects: 11 children who weighed between 5.9 and 54 kg (2 emergencies) with symptomatic extrahepatic portal hypertension.

Intervention: Interposition of venous autograft between the superior mesenteric vein and the distal (umbilical) portion of the left portal vein.

Main Outcome Measures: Improvements in symptoms and endoscopic appearance after operation.

Results: 2 bypasses had to be redone because they stenosed; all 11 were patent at the time of writing (median follow-up 6 months, range 1-32 months).

Conclusion: The bypass effectively relieved symptoms of extrahepatic portal hypertension by restoring normal hepatic portal blood flow.