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Erschienen in:

10.01.2021 | Original Article

Optimal Rex shunt procedures as a treatment for pediatric extrahepatic portal hypertension

verfasst von: Yu-Qing Zhang, Qing Wang, Mei Wu, Zheng -Min Ruan, Ya Li, Xiu -Liang Wei, Fei-Xue Zhang, Yan Li, Guang-Rui Shao, Juan Xiao

Erschienen in: Pediatric Surgery International | Ausgabe 5/2021

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Abstract

Purpose

To assess the long-term results after Rex bypass (RB) shunt and Rex transposition (RT) shunt and determine the optimal approach.

Methods

Between 2010 and 2019, traditional RB shunt was performed in 24 patients, and modified RT shunt was performed in 23 children with extrahepatic portal hypertension (pHTN). A retrospective study was conducted based on comparative symptoms, platelet counts, color Doppler ultrasonography and computed tomographic portography of the portal system, and gastroscopic gastroesophageal varices postoperatively. The portal venous pressure was evaluated intraoperatively.

Results

The operation in the RB group was notably more time-consuming than that in the RT group (P < 0.05). Compared to RT shunt, the reduction in gastroesophageal varix grading, the increases in platelets, and the caliber of the bypass were greater in the RB group (P < 0.05). Although not statistically significant, higher morbidity of surgical complications was found after RT shunt (17.4%) compared with RB shunt (8.3%) with patency rates of 82.6 and 91.7%, respectively. Additionally, patients exhibited a lower rate of rebleeding under the RB procedure (12.5%) than under the RT procedure (21.7%).

Conclusions

The RT procedure is an alternative option for the treatment of pediatric extrahepatic pHTN, and RB shunt is the preferred procedure in our center.

Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK (1992) Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 16:1343–1349. https://doi.org/10.1002/hep.1840160607CrossRefPubMed

Bayraktar Y, Balkanci F, Kayhan B, Uzunalimoglu B, Ozenc A, Ozdemir A, Dündar S, Arslan S, Sivri B, Telatar H (1997) Congenital hepatic fibrosis associated with cavernous transformation of the portal vein. Hepatogastroenterology 44:1588–1594PubMed

Wang RY, Wang JF, Liu Q, Ma N, Chen WX, Li JL (2017) Combined Rex-bypass shunt with pericardial devascularization alleviated prehepatic portal hypertension caused by cavernomatous transformation of portal vein. Postgrad Med 129:768–776. https://doi.org/10.1080/00325481.2017.1343646CrossRefPubMed

Kim SJ, Oh SH, Jo JM, Kim KM (2013) Experiences with endoscopic interventions for variceal bleeding in children with portal hypertension: a single center study. PediatrGastroenterolHepatolNutr 16:248–253. https://doi.org/10.5223/pghn.2013.16.4.248CrossRef

Junco PT, Alvarez A, Dore M, Gomez JJ, Galán AS, Vilanova-Sánchez A, Andres A, Encinas JL, Martinez L, Hernandez F, Santamaria ML (2019) Long-term results after diversion surgery in extrahepatic portal vein obstruction. Eur J PediatrSurg 29:23–27. https://doi.org/10.1055/s-0038-1668147CrossRef

DomínguezAmillo E, De la Torre RC, Andrés Moreno A, Encinas Hernández JL, Hernández Oliveros F, LópezSantamaría M (2017) Results of the mesoportal bypass (Rex shunt) in the treatment of idiopathic extrahepatic portal vein obstruction in children. Cir Pediatr 30:22–27

de Ville de Goyet J, Clapuyt P, Otte JB, (1992) Extrahilarmesenterico-left portal shunt to relieve extrahepatic portal hypertension after partial liver transplant. Transplantation 53:231–232

Lautz TB, Keys LA, Melvin JC, Ito J, Superina RA (2013) Advantages of the Meso-Rex bypass compared with portosystemic shunts in the management of extrahepatic portal vein obstruction in children. J Am CollSurg 216:83–89. https://doi.org/10.1016/j.jamcollsurg.2012.09.013CrossRef

Luoto T, Pakarinen M, Mattila I, Rintala R (2012) Mesoportal bypass using a constructed saphenous vein graft for extrahepatic portal vein obstruction—technique, feasibility, and outcomes. J PediatrSurg 47:688–693. https://doi.org/10.1016/j.jpedsurg.2011.10.065CrossRef

10.

Cortez AR, Kassam A-F, Jenkins TM, Nathan CJ, Nathan JD, Alonso MH, Ryckman FC, Tiao GM, Bondoc AJ (2019) The role of surgical shunts in the treatment of pediatric portal hypertension. Surgery 166:907–913. https://doi.org/10.1016/j.surg.2019.05.009CrossRefPubMed

11.

de Franchis R, Faculty BV (2015) Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol 63:743–752. https://doi.org/10.1016/j.jhep.2015.05.022CrossRefPubMed

12.

Ruan Z, Wu M, Shao C, Zhang Y, Zhang C, Zhang F, Zhao B (2020) Effects of Rex-bypass shunt on the cavernous transformation of the portal vein in children: evaluation by the color Doppler ultrasonography. Insights Imaging 11:4. https://doi.org/10.1186/s13244-019-0815-6CrossRefPubMedPubMedCentral

13.

Wang RY, Wang JF, Sun XG, Liu Q, Xu JL, Lv QG, Chen WX, Li JL (2017) Evaluation of rex shunt on cavernous transformation of the portal vein in children. World J Surg 41:1134–1142. https://doi.org/10.1007/s00268-016-3838-xCrossRefPubMed

14.

Tajiri T, Yoshida H, Obara K et al (2010) General rules for recording endoscopic findings of esophagogastricvarices (2nd edition). Dig Endosc 22:1–9. https://doi.org/10.1111/j.1443-1661.2009.00929.xCrossRefPubMed

15.

Lautz TB, Sundaram SS, Whitington PF, Keys L, Superina RA (2009) Growth impairment in children with extrahepatic portal vein obstruction is improved by mesenterico-left portal vein bypass. J PediatrSurg 44:2067–2070. https://doi.org/10.1016/j.jpedsurg.2009.05.016CrossRef

16.

Sharif K, McKiernan P, de Ville de Goyet J (2010) Mesoportal bypass for extrahepatic portal vein obstruction in children: close to a cure for most! J PediatrSurg 45:272–276. https://doi.org/10.1016/j.jpedsurg.2009.08.019CrossRef

17.

Ateş O, Hakgüder G, Olguner M, Akgür FM (2003) Extrahepatic portal hypertension treated by anastomosing inferior mesenteric vein to left portal vein at rexrecessus. J PediatrSurg 38:E10–E11. https://doi.org/10.1016/s0022-3468(03)00520-7CrossRef

18.

Chiu B, Pillai SB, Sandler AD, Superina RA (2007) Experience with alternate sources of venous inflow in the meso-Rex bypass operation: the coronary and splenic veins. J PediatrSurg 42:1199–1202. https://doi.org/10.1016/j.jpedsurg.2007.02.033CrossRef

19.

Zhang JS, Li L, Cheng W (2018) Surgical treatment for rebleeding caused by bypass failure after Rex shunt: re-Rex shunt or Warren shunt? PediatrSurgInt 34:521–527. https://doi.org/10.1007/s00383-018-4246-0CrossRef

20.

Superina R, Bambini DA, Lokar J, Rigsby C, Whitington PF (2006) Correction of extrahepatic portal vein thrombosis by the mesenteric to left portal vein bypass. Ann Surg 243:515–521. https://doi.org/10.1097/01.sla.0000205827.73706.97CrossRefPubMedPubMedCentral

21.

Bhat R, Lautz TB, Superina RA, Liem R (2013) Perioperative strategies and thrombophilia in children with extrahepatic portal vein obstruction undergoing the meso-rex bypass. J GastrointestSurg 17:949–955. https://doi.org/10.1007/s11605-013-2155-zCrossRef

22.

Zhang JS, Li L, Cheng W (2017) The optimal procedure of modified Rex shunt for the treatment of extrahepatic portal hypertension in children. J VascSurg Venous LymphatDisord 5:805–809. https://doi.org/10.1016/j.jvsv.2017.02.011CrossRef

Titel: Optimal Rex shunt procedures as a treatment for pediatric extrahepatic portal hypertension
verfasst von: Yu-Qing Zhang
Qing Wang
Mei Wu
Zheng -Min Ruan
Ya Li
Xiu -Liang Wei
Fei-Xue Zhang
Yan Li
Guang-Rui Shao
Juan Xiao
Publikationsdatum: 10.01.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Surgery International / Ausgabe 5/2021
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-020-04847-1

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Optimal Rex shunt procedures as a treatment for pediatric extrahepatic portal hypertension