Background:  Patients with extrahepatic portal hypertension may have to undergo splenorenal shunt surgery which requires a patent splenic vein of adequate calibre with a normal renal vein . This study reports a modification of splenorenal shunt for portal hypertension in children obviating the need for complex splenic vein-pancreatic disconnection.

Methods: 12 children with extrahepatic portal hypertension receiving the modified procedure were included. Indications for surgery were: recurrent hematemesis after endoscopic ablation of oesophageal varices in eight, hematemesis during sclerotherapy in two, and hematemesis in two patients coming from remote places. All patients had massive splenomegaly with hypersplenism. CT venogram demonstrated a cavernomatous transformation of the extrahepatic portal vein. The cavernoma extended up to the splenic vein and the superior mesenteric vein in six. After control of hematemesis and correction of coagulopathy, splenectomy was done with premeditated preservation of terminal tributaries of splenic vein, long and wide enough for anastomosis with left adrenal or renal vein without the need of tedious splenic vein-pancreatic disconnection.

Results: With completion of shunt, a significant reduction in the splenic vein pressure was noted in all patients. Recurrent hematemesis occurred in two patients while another two had ascites. CT venogram after one-year follow-up in eight patients revealed patent shunt in seven.

Conclusion: In patients with massive splenomegaly, during splenectomy for splenoadrenal shunt, premeditated preservation of a long terminal tributary of splenic vein and its use for splenoadrenal or splenorenal shunt can obviate the need of complex splenic vein-pancreatic disconnection.