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01.03.2011 | Original Article

Recanalized umbilical vein as a conduit for mesenterico/porto-Rex bypass for patients with extrahepatic portal vein obstruction

verfasst von: Masato Shinkai, Youkatsu Ohhama, Shohei Honda, Norihiko Kitagawa, Kyoko Mochizuki, Hiroshi Take, Yoshihiro Hirata, Yoshiko Usui, Jun Shibasaki, Hideaki Ueda, Noriko Aida

Erschienen in: Pediatric Surgery International | Ausgabe 3/2011

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Abstract

Purpose

Mesenterico-left portal vein (meso-Rex) bypass is as an effective modality for restoring intrahepatic portal perfusion in patients with extrahepatic portal vein obstruction. Achieving sufficient patency is difficult with end-to-side anastomosis of a bypass graft to a small or hypoplastic left portal vein in the Rex recessus. Here, we describe the use of a recanalized umbilical vein in the round ligament as a conduit for bypass construction in two patients.

Methods

Case 1 was an 11-year-old boy diagnosed with rupture of the esophageal varices and hypersplenism due to congenital extrahepatic portal hypertension. Because of persistent hypersplenism and thrombocytopenia, he underwent meso-Rex bypassing with a left iliac vein graft interposed between the umbilical vein and the superior mesenteric vein. Case 2 was a neonate with a large hepatic tumor (mesenchymal hamartoma) that developed abdominal compartment syndrome at birth. The tumor was removed by right hepatectomy with excision of the portal vein bifurcation at 3 days of age. Porto-Rex bypassing was accomplished by end-to-end anastomosis between the portal vein trunk and the umbilical vein.

Results

Sufficient hepatopetal portal flow through the umbilical vein was achieved in both patients and maintained for over 16 and 13 months, respectively. Although hypersplenism remained in Case 1, intrahepatic portal vein branches gradually widened and the cavernoma in the hepatic hilum disappeared within 2 months. Neither patient had symptoms or signs of portal hypertension at the most recent follow-up.

Conclusion

Using the umbilical vein as a vein conduit may facilitate construction of a meso/porto-Rex bypass and restore intrahepatic portal vein perfusion in patients with extrahepatic portal vein obstruction.

Botha JF, Campos BD, Grant WJ et al (2004) Portosystemic shunts in children: a 15-year experience. J Am Coll Surg 199:179–185CrossRefPubMed

Emre S, Dugan C, Frankenberg T et al (2009) Surgical portosystemic shunts and the Rex bypass in children: a single-center experience. HPB 11:252–257CrossRefPubMed

de Ville de Goyet J, Alberti D, Clapuyt P et al (1998) Direct bypassing of extrahepatic portal venous obstruction in children: a new technique for combined hepatic portal revascularization and treatment of extrahepatic portal hypertension. J Pediatr Surg 33:597–601CrossRefPubMed

Superina R, Shneider B, Emre S et al (2006) Surgical guidelines for the management of extra-hepatic portal vein obstruction. Pediatr Transplant 10:908–913CrossRefPubMed

Fuchs J, Warmann S, Kardoff R et al (2003) Mesenterico-left portal vein bypass in children with congenital extrahepatic portal vein thrombosis: a unique curative approach. J Pediatr Gastroenterol Nutr 36:213–216CrossRefPubMed

Krebs-Schmitt D, Briem-Richiter A, Grabhorn E et al (2009) Effectiveness of Rex shunt in children with portal hypertension following liver transplantation or with primary portal hypertension. Pediatr Transplant 13:540–544CrossRefPubMed

Kumada K, Ozawa K, Shimahara Y et al (1990) Truncoumbilical bypass of the portal vein in radical resection of biliary tract tumour involving the hepatic duct confluence. Br J Surg 77:749–751CrossRefPubMed

de Ville de Goyet J, Gibbs P, Clapuyt P et al (1996) Original extrahilar approach for hepatic portal revascularization and relief of extrahepatic portal hypertension related to later portal vein thrombosis after pediatric liver transplantation. Long term results. Transplantation 62(1):71–75CrossRefPubMed

Ogita K, Taguchi T, Soejima Y et al (2005) Fatty liver caused by portal vein thrombosis after living donor liver transplantation: a case report. J Pediatr Surg 40:E7–E9CrossRefPubMed

10.

de Goyet J, Alberti D, Clapuyt P et al (1998) Direct bypassing of extrahepatic portal venous obstruction in children: a new technique for combined hepatic portal revascularization and treatment of extrahepatic portal hypertension. J Pediatr Surg 33(4):597–601CrossRef

11.

Kuroda Y, Tanioka Y, Ku Y et al (1996) Centrifugal pump-assisted venous bypass between the superior mesenteric vein and the umbilical vein during portal vein resection. Surg Today Jpn J Surg 26:762–764CrossRef

12.

Soejima Y, Shimada M, Suehiro T et al (2006) Reconstruction of the middle hepatic vein tributaries using the recipient’s recanalized umbilical vein in right-lobe living-donor liver transplantation. Surgery 139:442–445CrossRefPubMed

13.

Mergental H, Gouw ASH, Slooff MJH et al (2007) Venous outflow reconstruction with surgical reopened obliterated umbilical vein in domino liver transplantation. Liver Transplant 13:769–772CrossRef

14.

Facciuto ME, Rodrigeuex-Davalos MI, Singh MK et al (2009) Recanalized umbilical vein conduit for meso-Rex bypass in extrahepatic portal vein obstruction. Surgery 145:406–410CrossRefPubMed

15.

Gehrke I, John P, Blundell J et al (2003) Meso-portal bypass in children with portal vein thrombosis: rapid increase of the intrahepatic portal venous flow after direct portal hepatic reperfusion. J Pediatr Surg 38:1137–1140CrossRefPubMed

16.

Vlessis AA, Hovaguimian H, Arntson E et al (1995) Use of autologous umbilical artery and vein for vascular reconstruction in the newborn. J Thorac Cardiovasc Surg 109:854–857CrossRefPubMed

17.

Dunning J, Versteegh M, Fabbri A et al (2008) Guideline on antiplatelet and anticoagulation management in cardiac surgery. Eur J Cardiothorac Surg 34:73–92CrossRefPubMed

18.

Duffy JP, Hong JC, Farmer DG et al (2009) Vascular complications of orthotopic liver transplantation: experience in more than 4,200 patients. J Am Coll Surg 208:896–905CrossRefPubMed

Titel: Recanalized umbilical vein as a conduit for mesenterico/porto-Rex bypass for patients with extrahepatic portal vein obstruction
verfasst von: Masato Shinkai
Youkatsu Ohhama
Shohei Honda
Norihiko Kitagawa
Kyoko Mochizuki
Hiroshi Take
Yoshihiro Hirata
Yoshiko Usui
Jun Shibasaki
Hideaki Ueda
Noriko Aida
Publikationsdatum: 01.03.2011
Verlag: Springer-Verlag
Erschienen in: Pediatric Surgery International / Ausgabe 3/2011
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-010-2742-y

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Recanalized umbilical vein as a conduit for mesenterico/porto-Rex bypass for patients with extrahepatic portal vein obstruction