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One step minilaparotomy-assisted transmesenteric portal vein recanalization combined with transjugular intrahepatic portosystemic shunt placement: A novel surgical proposal in pediatrics

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World Journal of Gastroenterology 2017年第15期23卷 2811-2818页

作者： Gloria Pelizzo Pietro Quaretti Lorenzo Paolo Moramarco Riccardo Corti Marcello Maestri Giulio Iacob Valeria Calcaterra Department of Clinical SurgicalDiagnostic and Pediatric SciencesUniversity of Pavia Pediatric Surgery Unit Ospedale dei Bambini“G.di Cristina”Istituto Mediterraneo di Eccellenza Pediatrica Unit of Interventional Radiology Fondazione IRCCS Policlinico San Matteo Radiology Department IRCCS Policlinico San Matteo Foundation Department of Surgery IRCCS Policlinico San Matteo Foundation Pediatric Unit Department of Maternal and Children's HealthFondazione IRCCS Policlinico San Matteo Department of Internal Medicine and Therapeutics University of Pavia

Transjugular intrahepatic portosystemic shunt(TIPS) placement is a standard procedure for the treatment of portal hypertension complications. When this conventional approach is not feasible, alternative procedures for systemic diversion of portal blood have been proposed. A one-step interventional approach, combining minilaparotomy-assisted transmesenteric(MAT) antegrade portal recanalization and TIPS, is described in an adolescent with recurrent esophageal varice bleeding and portal cavernoma(PC). A 16-yearold girl was admitted to our Unit because of repeated bleeding episodes over a short period of time due to esophageal varices in the context of a PC. A portal vein recanalization through an ileocolic vein isolation with the MAT approach followed by TIPS during the same session was performed. In the case of failed portal recanalization, this approach, would also be useful for varice endovascular embolization. Postoperative recovery was uneventful. Treatment consisting of propanolol, enoxaparin and a proton pump inhibitor was prescribed after the procedure. One month post-op, contrast enhanced computed tomography confirmed the patency of the portal and intrahepatic stent grafts. No residual peritoneal fluid was detected nor opacification of the large varices. Endoscopy showed good improvement of the varices. Doppler ultrasound confirmed the accelerated flow in the portal stent and hepatopetal flow inside the intrahepatic portal branches. Three months post-op, TIPS maintained its hourglass shape despite a slight expansion. Portal hypertension and life threatening conditions related to PC would benefit from one-step portal recanalization. MAT-TIPS is feasible and safe for the treatment of PC even in children. This minimally invasive procedure avoids or delays surgical treatment or re-transplantation when necessary in pediatric patients.

关键词： Portal cavernoma Pediatrics Transjugular intrahepatic portosystemic shunt minilaparotomy-assisted transmesenteric

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