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Alberti, Daniele*; D’Antiga, Lorenzo†
*Paediatric Surgery, University of Brescia, Presidio Ospedale dei Bambini, Brescia
†Paediatric Hepatology, Gastroenterology, and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
To the Editor:
Our study reports the outcome of children with extrahepatic portal vein obstruction managed prospectively with the same protocol for 15 years, without any selection. In this protocol, surgery (with priority to meso-portal bypass [MPB]) was indicated only after the failure of medical and endoscopic treatments. Accurate methodology suggested considering our latest cases, which had a preemptive MPB, as violations. With these data, we could certainly not argue in favor of or against different approaches, although the violations tell that we probably agree with the comment made.
We hope that Drs Superina and de Ville will have the chance to produce similar data on a large, unselected population of children presenting with extrahepatic portal vein obstruction and managed prospectively with a protocol considering preemptive MPB as the first step. We look forward to reading such a study that could prove that preemptive MPB is superior to MPB carried out as a second-line treatment (1). Meanwhile, we appreciate the comment and we agree with what, at the moment, is an expert opinion (2).
© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,
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