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Eur J Pediatr Surg
DOI: 10.1055/a-2789-0007
Original Article

Novel Bedside Ligation for Staged Closure of Congenital Portosystemic Shunts: A Single-Center Experience in 20 Children

Autor*innen

  • Sheng Chen   ‡

    1   Department of General Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
    2   Department of General Surgery, Guizhou Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Guiyang, Guizhou, China

  • Huaying Zhao   ‡

    1   Department of General Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China

  • Zhoulonglong Xie

    1   Department of General Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China

  • Dongyu Mei

    1   Department of General Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China

  • Chen Guo

    3   Department of Radiology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China

  • Qimin Chen

    1   Department of General Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China

  • Jun Chu

    1   Department of General Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China

  • Zhilong Yan 

    1   Department of General Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China

Funding Information This work was supported by the Health Commission of Guizhou Province, gzwkj2024–430 Guizhou Provincial Science and Technology Department Science and Technology Program of Guizhou Province LC [2024]107.
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Abstract

Objective

To report our institutional experience with a portal venous pressure (PVP)-guided surgical strategy for congenital portosystemic shunts (CPSs) and introduce a novel bedside ligation technique for staged shunt closure.

Methods

We retrospectively reviewed 20 children who underwent surgical CPS closure between 2013 and 2023. The surgical approach was determined by intraoperative PVP during temporary shunt occlusion. One-stage ligation was performed when PVP remained < 25 mm Hg, whereas shunts with PVP ≥ 25 mm Hg were banded for staged closure using either bedside ligation or endovascular completion.

Results

Fourteen patients (70%) underwent one-stage closure (median PVP: 22.0 mm Hg, interquartile range [IQR]: 18.0–22.5), and six (30%) required two-stage closure (median PVP: 28.0 mm Hg, IQR: 25.8–29.5). Among the latter, five achieved complete shunt occlusion through the bedside technique, avoiding reoperation or readmission. The primary composite outcome—radiologic closure, fasting blood ammonia normalization, and absence of severe complications—was achieved in all 20 patients (100%) at 1-year follow-up. Significant intrahepatic portal vein (IPV) remodeling was observed, with median left and right IPV diameters increasing from 1.4 and 1.6 to 4.8 and 5.0 mm, respectively (both p < 0.0001). The overall complication rate was 15% (3/20), all Clavien–Dindo Grades I to II.

Conclusion

In children with CPSs unsuitable for endovascular closure, a PVP-guided surgical strategy appears safe and effective. For those requiring two-stage closure due to elevated PVP, bedside ligation after Endoloop banding provides a feasible, less invasive alternative to reoperation. However, larger studies are needed to confirm its safety and efficacy.

Keywords

Abernethy malformation - portal vein anomaly - congenital portosystemic shunts - children - surgery

‡ These authors share first authorship.


Supplementary Material



Publikationsverlauf

Eingereicht: 19. Oktober 2025

Angenommen: 14. Januar 2026

Accepted Manuscript online:
16. Januar 2026

Artikel online veröffentlicht:
30. Januar 2026

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