Use of the Rex Shunt in Adults for Left Portal Vein Reconstruction

Abstract

Introduction: To report an expanded use of Rex shunt (RS) for portal vein (PV) reconstruction in adults. The RS was developed to treat children with extrahepatic portal vein thrombosis (EHPVT) following liver transplantation or with a healthy liver. Method: An RS was used to achieve portal reperfusion during various liver surgeries when a standard porto-left portal anastomosis was deemed technically unsatisfactory or incompatible with right-sided R0 onco-surgical resection. Results: This study involved 5 male and 6 female patients (median age, 59 years). The RS was feasible in all 11 consecutive attempts, including hepatectomy for malignancy combined with PV resection in 9 (82%) patients where the left lobe or liver was left in place.A reinforced Gore-Tex graft was used in 10 patients and an allogenic iliac vein was used in 1 patient.Within 90 days, 1 patient with a patent shunt had died of pulmonary embolism, and 1 patient had died of diffuse PVT with multiple organ failure.In 4 patients, postoperative complications included ascites, biliary fistula, and shunt thrombosis.At a median 13.5-month follow-up, 7 patients with a patent shunt remained alive. A systematic review of RS in adults identified 11 cases in 8 reports performed mainly for EHPVT (9 patients). In 2 patients, postoperative complications involved transient ascites and abdominal bleeding requiring surgical revision.Postoperative mortality was nil. The median long-term patency rate was 24 months. Conclusion: Use of the RS in adults is straightforward, offering a supplementary technical option for left portal reconstruction in patients with malignancy or EHPVT,provided the downstream portal system is normal.