Optimal procedure of modified Rex shunt for extrahepatic portal hypertension in children

Abstract

Objective To explore the outcomes of modified Rex shunt in the treatment of extra-hepatic portal hypertension in children. Methods From February 2008 to March 2016, 101 patients with extrahepatic portal hypertension underwent Rex shunting at our hospital.The procedures included gastric coronary vein-left portal vein shunt (CV-LPV, n=48), main portal vein-left portal vein shunt with interposition of portal vessels (iPV-LPV, n=26), proximal splenic vein-left portal vein shunt (SV-LPV, n=5), splenic vein-left portal vein with interposition of portal vessels (iSV-LPV, n=6), inferior mesenteric vein-left portal vein shunt (IMV-LPV, n=2), double gastric coronary vein-left portal vein bypass (dCV-LPV, n=4), right gastric vein-left portal vein bypass (RGV-LPV, n=4), right gastroepiploic vein-left portal vein bypass (RGEV-LPV, n=4) and Roux-Y jejunal vein-left portal vein bypass (RYV-LPV, n=2). Operative duration, postoperative portal vein pressure, size of spleen, postoperative hospitalization stay, postoperative rebleeding rate, diameter and blood flow of bypass vein were compared among various Rex shunts. Results Rex shunt was successfully performed in 101 patients.Operative duration: CV-LPV was significantly higher than iPV-LPV (P=0.036). iSV-LPV significantly higher than CV-LPV, iPV-LPV, RGV-LPV, RGEV-LPV and RYV-LPV (P=0.024, P=0.001, P=0.039, P=0.039 & P=0.145). Postoperative mesenteric venous pressure: iSV-LPV significantly was higher than iPV-LPV, dCV-LPV and RYV-LPV (P 0.05). Conclusions Modified Rex shunts are efficacious for extrahepatic portal hypertension in children.And iPV-LPV is a preferred procedure of Rex shunt. Key words: Hypertension, portal; Child; Rex shunt