Background/Objectives: Management of prehepatic portal hypertension involves endoscopic and medical therapies with subsequent shunting if symptoms persist. Lately, surgical shunts, particularly the Meso-Rex shunt, are increasingly considered early in the disease course, offering benefits such as minimized hyperammonemia, improved somatic growth, and preservation of liver function. Our study evaluates post-operative outcomes after different surgical procedures in children with prehepatic portal hypertension. Methods: This single-centre retrospective case series included six children undergoing surgical shunting for prehepatic portal hypertension over a 5-year period. Medical records before and after surgery, followed for an average of 4.0 years, were analyzed. Results: Five patients underwent a Meso-Rex bypass, while one patient underwent a mesorenal shunt procedure. All cases showed clinically significant regression of esophageal varices six months postsurgery. Thrombocyte as well as leukocyte count significantly increased in five out of six patients during the long-term follow-up. Currently, five out of six surgically formed shunts (83%) continue to function normally. Conclusions: Our study supports early surgical intervention for improved long-term outcomes in managing portal hypertension, reducing complications like hypersplenism and variceal bleeding. Early consideration and ongoing monitoring are crucial for long-term success in children with portal hypertension.
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