Growth impairment in children with extrahepatic portal vein obstruction is improved by mesenterico-left portal vein bypass

Lautz, Timothy B.; Sundaram, Shikha S.; Whitington, Peter F.; Keys, Lisa; Superina, Riccardo A.

doi:10.1016/j.jpedsurg.2009.05.016

« Previous Next »Journal of Pediatric Surgery
Volume 44, Issue 11 , Pages 2067-2070, November 2009

Growth impairment in children with extrahepatic portal vein obstruction is improved by mesenterico-left portal vein bypass

Timothy B. Lautz
- Department of Surgery, Children's Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, IL 60611, USA
- Corresponding author. Tel.: +1 312 282 5761; fax: +1 312 926 7404.
Shikha S. Sundaram
- Department of Gastroenterology, Children's Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, IL 60611, USA
Peter F. Whitington
- Department of Gastroenterology, Children's Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, IL 60611, USA
Lisa Keys
- Department of Surgery, Children's Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, IL 60611, USA
Riccardo A. Superina
- Department of Surgery, Children's Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, IL 60611, USA

Received 18 April 2009; received in revised form 12 May 2009; accepted 13 May 2009.

Abstract

Background

Extrahepatic portal vein obstruction (EHPVO) has been associated with growth impairment in children. We hypothesized that growth parameters improve after reversal of portal hypertension and restoration of mesenteric venous blood flow to the liver by the mesenterico-left portal vein bypass (MLPVB).

Methods

A retrospective review of 45 children with idiopathic EHPVO who underwent MLPVB between 1997 and 2007 and had follow-up data for analysis was carried out. Growth was assessed using SD scores (z scores) for height, weight, and body mass index (BMI) at the time of operation and at early (5-12 months) and late (13-24 months) follow-up.

Results

The mean height and weight of children with EHPVO was significantly lower than the general population before surgery. Mean BMI was also lower, although statistically insignificant. All parameters increased significantly after MLPVB as follows: height from −0.42 before surgery to −0.12 (P = .027) at 5 to 12 months and −0.14 (P = .026) at 13 to 24 months; weight from −0.49 before surgery to 0.03 (P < .001) at 5 to 12 months and 0.35 (P < .001) at 13 to 24 months; and BMI from −0.22 before surgery to 0.17 (P = .001) at 5 to 12 months and 0.48 (P < .001) at 13 to 24 months.