Clinical efficacy of Rex shunt in treatment of cavernous transformation of portal vein in children

Abstract

Objective To investigate the feasibility and clinical efficacy of superior mesenteric vein-left portal vein anastomosis (Rex) for cavernous transformation of portal vein in children. Methods Clinical data of 54 children with cavernous transformation of portal vein admitted to Guangzhou Women and Children’s Medical Center from October 2014 to June 2018 were retrospectively analyzed. Among them, 36 patients were male and 18 female, aged from 11 months to 15 years with a median age of 7 years and 1 month. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were diagnosed with cavernous transformation of portal vein by abdominal ultrasound and CT scan. That whether the left portal vein sagittal region was opened or not was further confirmed by digital subtraction angiography (DSA). The portal inflow channel was reconstructed through end-to-side anastomosis of the left portal vein sagittal region and the superior mesenteric vein by Rex approach. Results The Rex fossa was explored during the operation. The left portal vein sagittal region was opened and the blood flow was good in 49 cases, who successfully completed the Rex shunt. The remaining5 cases underwent selective distal splenorenal shunt due to sagittal region occlusion or hypoplasia of the left portal vein. During the Rex shunt, left internal jugular veins were used as the bypass vessels in39 cases, and coronary veins in 7 cases, right gastric omentum veins in 2 cases, cadaveric hepatic iliac artery in1 case, respectively. All patients were followed up. Good clinical effect was observed in 92%(45/49) of the patients after Rex shunt, while 4 cases suffered from recurrent hemorrhage. 16 cases received gastroscopy at postoperative 1 year, where varicose veins was observed eliminated in 5 cases, relieved in 10 and no effect in 1 case. Conclusions Rex shunt can achieve satisfactory clinical effect in the treatment of cavernous transformation of portal vein in children. The opened left portal vein sagittal region is a necessary factor for Rex shunt. Rex fossa exploration during the operation is the most reliable method to evaluate whether the left portal vein sagittal region is opened. The internal jugular vein is the most commonly used bypass vessel. Key words: Cavernous transformation of portal vein; Rex shunt; Child