Surgical closure of congenital portosystemic shunts in children A modified classification for transitioning to minimal-invasive repair.

jpedsurg.org

Congenital portosystemic shunts (CPSS) are rare malformations of visceral vessels that lead to poor or absent intrahepatic portal flow. Therapeutic options have shifted away from liver transplantation towards either interventional or surgical closure with excellent results. The challenge to reliably predict portal venous pressure response to shunt occlusion, paired with significant interindividual variability of shunt anatomy have hindered the structured transition from open to minimal invasive surgical shunt closure.

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Article · Oct 2025 · 1 min read

In brief

This article addresses surgical management of congenital portosystemic shunts in pediatric patients, focusing on a modified classification system to guide the transition from open to minimally invasive repair techniques. The authors tackle key challenges including predicting portal pressure responses and accommodating variable shunt anatomy to optimize surgical outcomes.

CPSS cause absent intrahepatic portal flow; treatment has shifted from transplant to shunt closure with excellent outcomes.
Predicting portal venous pressure response to shunt occlusion remains challenging and limits minimally invasive approaches.
Significant anatomic variability in CPSS anatomy complicates standardized transition to minimally invasive surgical techniques.
Both interventional and surgical closure are now preferred over liver transplantation for CPSS management.
A modified classification system may facilitate structured adoption of minimally invasive CPSS repair in pediatric patients.

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