Unconventional Alternative Shunts in Pediatric Extrahepatic Portal Vein Obstruction – Experience with satisfactory outcome.

jpedsurg.org

Major variceal hemorrhages in children of the Indian subcontinent, are caused by extrahepatic portal vein obstruction (EHPVO). Portosystemic shunt surgery (PSS) is the recommended course of action for long-term care in refractory cases, even if endoscopic techniques constitute the initial line of treatment for acute variceal hemorrhage. The most usual surgery, particularly with splenomegaly, is the proximal splenorenal shunt (PSRS). However, in some cases, unusual or alternative nonconventional shunts are required for treatments due to anatomical variances and technical difficulties.

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Article · Jul 2025 · 1 min read

In brief

This article describes surgical management of extrahepatic portal vein obstruction in pediatric patients, focusing on alternative shunt techniques when standard proximal splenorenal shunts are not feasible. The authors share their experience with unconventional portosystemic shunt approaches for children with refractory variceal bleeding due to anatomical variations.

EHPVO is the leading cause of variceal bleeding in Indian subcontinent children; endoscopic therapy is first-line for acute hemorrhage.
Portosystemic shunt surgery provides definitive long-term management when endoscopic treatment fails or bleeding recurs.
Proximal splenorenal shunt is the standard PSS, especially when splenomegaly is present.
Anatomical variations may necessitate unconventional shunt configurations to achieve adequate portal decompression.
Alternative shunt techniques can yield satisfactory outcomes when conventional PSRS is not technically feasible.

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