Side-to-side Lienorenal (Mitra) Shunt in Children with Portal Hypertension: A Single-center Review of Indications and Outcomes

A BSTRACT Background: Extrahepatic portal venous obstruction (EHPVO) is a leading cause of portal hypertension in children, particularly in developing countries. Although endotherapy is effective for acute variceal bleeding, surgical shunts are often required for secondary prophylaxis or when endoscopic therapy fails. This study evaluates the feasibility, safety, and short-term outcomes of the spleen-preserving side-to-side lienorenal (Mitra) shunt in children with EHPVO unsuitable for mesorex bypass (MRB). Materials and Methods: We retrospectively reviewed children (<18 years) with EHPVO who underwent Mitra shunt between July 2022 and October 2025. Preoperative evaluation included Doppler ultrasonography, computed tomography portovenography, and magnetic resonance (MR) cholangiopancreatography/MR portovenography when indicated. Primary outcomes included shunt patency and reduction in portal pressure. Secondary outcomes included complications and improvement in hypersplenism. Results: Thirteen children underwent the Mitra shunt. The median age was 8 years (range: 2–18), including 9 boys and 4 girls. Variceal bleed (10, 77%), Hypersplenism (8, 61.5%), and growth retardation (5, 38.5%) were the most common indications for shunt surgery. Median portal pressure decreased significantly from 37 cmH 2 O to 25 cmH 2 O ( P = 0.008). Mean platelet count increased from 75.2 × 10 3 /mm 3 to 109.7 × 10 3 /mm 3 . Patients were followed up for a median duration of 10 months (range: 3–26 months). No operative mortality occurred. All shunts remained patent during follow-up. Conclusion: The Mitra shunt is a feasible and promising surgical option in selected children with EHPVO unsuitable for MRB, providing reliable portal decompression and improvement in hypersplenism.