{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:20:20Z","timestamp":1787772020704,"version":"build-2784847793"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives:<\/jats:title>\n                    <jats:p>More than 20% of patients with extrahepatic portal vein obstruction (EHPVO) may be deemed as nonshuntable due to lack of a suitable vein. The role of \u201cmakeshift shunts\u201d or \u201clesser shunts\u201d assumes importance in such cases. In this report, the authors have shared their experience with the makeshift shunts in the management of portal hypertension in children with emphasis upon anatomic considerations, resolution of symptoms, outcomes after surgery, and shunt patency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      During the period 1983\u20132018, 138 children with portal hypertension were managed under the care of a single surgeon (VB). Of them, 134 were EHPVO. Children with EHPVO were treated with splenectomy and proximal lienorenal shunt (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 107), splenectomy and devascularization (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 21), and makeshift shunts (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 6). Makeshift shunts comprised (i) side-to-side right gastroepiploic vein (Rt-GEV) to left renal vein (LRV) shunt (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1), (ii) superior mesenteric vein (SMV) to inferior vena cava (IVC) shunt using a spiral saphenous venous graft (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1), (iii) side-to-side inferior mesenteric vein (IMV) to LRV shunt (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 2), (iv) side-to-side IMV to IVC shunt (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1), (v) end-to-side IMV to IVC shunt (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1), and (vi) side-to-side IMV to LRV shunt (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1) in a case of crossed fused renal ectopia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Following the creation of portosystemic shunt, a decline in portal pressure was demonstrated in all six patients. There was resolution of symptoms including hematemesis, melena, and anorectal variceal bleed. None of the patients demonstrated the features of hepatic encephalopathy. The associated portal cavernoma cholangiopathy (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1) also resolved following Rt-GEV to LRV shunt. Shunt patency was documented for the entire duration of follow-up (1.5\u20134 years) in five of six patients; the sixth patient demonstrated shunt block at 6-month follow-up but without recurrence of symptoms.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Makeshift shunts offer a viable alternative to standard portosystemic shunting in pediatric patients with a nonshuntable vein. The selection of such shunts is, however, subject to surgeon\u2019s preferences and has to be individualized to local anatomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jiaps.jiaps_21_21","type":"journal-article","created":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T06:00:55Z","timestamp":1709618455000},"page":"152-158","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Makeshift Shunts in Extrahepatic Portal Vein Obstruction in Pediatric Population"],"prefix":"10.4103","volume":"29","author":[{"given":"Prabudh","family":"Goel","sequence":"first","affiliation":[{"name":"Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veereshwar","family":"Bhatnagar","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikash Srinivasaiahsetty","family":"Chennur","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,3,4]]},"reference":[{"issue":"Suppl 3","key":"R1-20240905","first-page":"S228","article-title":"Portal hypertension in children:An Indian perspective","volume":"17","author":"Yachha","year":"2002","journal-title":"J Gastroenterol Hepatol"},{"key":"R2-20240905","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1097\/SLA.0b013e318070cada","article-title":"Therapeutic strategies in symptomatic portal biliopathy","volume":"246","author":"Vibert","year":"2007","journal-title":"Ann Surg"},{"key":"R3-20240905","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1067\/mge.2003.194","article-title":"Endoscopic sclerotherapy 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