engleski

Prehepatic Portal Hypertension: 43 Years of Follow-Up in Single Institution and 20 Years After Introduction of Sclerotherapy

Introduction: Surgery was treatment of choice for children with complications of prehepatic portal hypertension until sclerotherapy and band ligation has occurred. Introduction of octerotide was another landmark in treatment. We report a 43- year (first 26 retrospective and next 17 prospective) analysis of 64 patients. Methods: The charts of all patients treated before 1987 were reviewed retrospectively and from that year on a prospective evaluation based on database and registry has been started. Results: Between 1960 and Dec 2003 64 children were followed up between 2 and 43 years with a median of 17.4 years. We have divided our patients in two groups. First consisted of all patients (No 20) treated before the introduction of sclerotherapy (1984. in our hospital), and in the second group were remaining 44 patients. First symptom in historical group was hematemesis in 17 of 20 patients (85%). Thirteen palliative surgical interventions, and 4 shunt (spleno-renal) procedures were done in 14 patients (mortality rate 35%), a 6 patients were treated medically (mortality rate 33%). In group which was treated initially with sclerotherapy hematemesis was leading symptom in 54% of patients, and overall mortality rate is 9%. In this group, 20 patients along the course of their disease, due to failure of conservative therapy or other reasons were assigned for 25 operations. Mortality rate in combination therapy group is 12.5%. Rest of the patients (24) were treated only with sclerotherapy or octreotide. Mortality rate in this subgroup is only 5%. In the last 2 years, there was any new case of prehepatic portal hypertension and we are the only hospital in our country equipped for dealing with such a problem. There is a steady decline in incidence that has been observed for years probably due to disappearance of so far unknown etiological factor and improving neonatal practices. Conclusion: There is a decline in incidence of prehepatic portal hypertension. Sclerotherapy and octreotide have improved outcomes considerably, but there is still subset of patients who have to be operated. Our data support thesis that exist subgroup of patients who should be candidates for primary surgical procedure.

preportal hypertension ; children ; sclerotherapy

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