Assessment of the patency of the left portal vein during mesoportal shunting in children with extrahepatic portal hypertension

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BACKGROUND: One of the most common causes of extrahepatic portal hypertension in children is portal vein thrombosis. The causes of this disease are different and, in most cases, remain unrecognized. Along with this, the mesoportal shunt (Rex shunt) proved itself and today is considered the “gold standard” to treat extrahepatic portal hypertension in children. The restoration of hepatopetal blood flow eliminates gastroesophageal bleeding, splenomegaly, hypersplenism, and many other complications. For the results of mesoportal shunt to be successful, several conditions must be met, one of which is the patency of the umbilical portion of the left portal vein. Despite the importance of preoperative diagnostics of the patency of this area, the most optimal instrumental research method has not yet been found.

AIM: This literature review aims to highlight the main issues of extrahepatic portal hypertension etiopathogenesis, surgical treatment methods, and the most effective preoperative diagnostic methods to assess the patency of the left portal vein.

RESULTS: The authors analyzed the sources of domestic and foreign literature on the etiology, pathogenesis of HSV in children, and laboratory and instrumental diagnostic methods to assess the patency of the PVI to plan the mesoportal shunting operation.

CONCLUSIONS: Extrahepatic portal hypertension is a polyetiological disease with a possible hereditary predisposition to a thrombotic process under the influence of various triggers. The most common causes of portal vein thrombosis are omphalitis and umbilical vein catheterization in the neonatal period. Unfortunately, to date, none of the existing instrumental diagnostic methods can reliably answer the question about left portal vein patency. Due to the small number of works, the lack of a unified view on the problem of preoperative diagnosis of patients with extrahepatic portal hypertension, we could not reliably determine the specificity, sensitivity, and accuracy of each instrumental method. Therefore, we could not identify the “gold standard” method. Nevertheless, with further improvement of the methods for preoperative assessment of the left portal vein patency, surgeons will be more likely to predict the successful outcome of mesoportal shunting, which will generally affect the surgical treatment quality of extrahepatic portal hypertension in children.

作者简介

Daria Sokolova

N. F. Filatov Children’s Hospital; Pirogov Russian National Research Medical University

编辑信件的主要联系方式.
Email: daras9190@gmail.com
ORCID iD: 0000-0002-1229-8102

Pediatric surgeon resident

俄罗斯联邦, 1, Ostrovityanova st. Moscow 117997; 15, Sadovaya-Kudrinskaya str., Moscow

Zoricto Mitupov

N. F. Filatov Children’s Hospital; Pirogov Russian National Research Medical University

Email: zmitupov@mail.ru
ORCID iD: 0000-0002-0016-6444

Dr. Sci. (Med.), Pediatric surgeon

俄罗斯联邦, 15, Sadovaya-Kudrinskaya str., Moscow; 1 Ostrovityanova st. Moscow, 117997

Nikita Kurtak

Moscow Regional Research and Clinical Institute

Email: dr.kurtak@gmail.com
ORCID iD: 0000-0001-8615-3742

surgeon

俄罗斯联邦, Moscow

Alexander Razumovsky

N. F. Filatov Children’s Hospital; Pirogov Russian National Research Medical University

Email: 1595105@mail.ru
ORCID iD: 0000-0002-9497-4070

Dr. Sci. (Med.), professor, corresponding member of RAS

俄罗斯联邦, 15, Sadovaya-Kudrinskaya str., Moscow; 1 Ostrovityanova st. Moscow 117997

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