Abstract
BackgroundThe aim of this study was to evaluate whether variant meso-Rex bypass with transposition of abdominal autogenous vein can be used as an alternative treatment modality for selected patients with symptomatic extrahepatic portal vein obstruction.MethodsThis was a retrospective review of six consecutive patients who received this alternative procedure for the treatment of symptomatic portal hypertension secondary to idiopathic extrahepatic portal vein obstruction. Their clinical characteristics, operative procedures and outcomes were analyzed retrospectively.ResultsThe procedure was attempted in six patients, and all had a patent shunt established by intraoperative portography at the end of the procedure; the coronary vein was used in four patients and the inferior mesenteric vein was used in two. During the median period of 23.5 months (range 10–30 months), follow-up was uneventful except one patient; reduced portal hypertension and no new episodes of gastrointestinal bleeding were observed in all patients, with the exception of one patient with shunt stenosis and recurrent varix bleeding who had to undergo endovascular treatment to restore portal vein blood flow. Technical and clinical success was achieved in all patients.ConclusionsThis procedure could be used safely and effectively to treat selected patients with portal hypertension secondary to extrahepatic portal vein obstruction.
Highlights
The aim of this study was to evaluate whether variant meso-Rex bypass with transposition of abdominal autogenous vein can be used as an alternative treatment modality for selected patients with symptomatic extrahepatic portal vein obstruction
Ha et al BMC Surgery (2015) 15:116. This observational study included six consecutive patients who presented with symptomatic portal hypertension secondary to idiopathic extrahepatic portal vein obstruction (EHPVO) and underwent variant meso-Rex bypass (MRB) with transposition of abdominal autogenous vein at our hospital
Preoperative Doppler ultrasonography and computed tomography (CT) angiography revealed thrombosis or cavernous transformation of the main portal vein (PV) in all patients (Fig. 1); two patients had an intrahepatic PV that was adequate for shunting, but blood flow in the left PV in the other four patients was inadequate
Summary
The aim of this study was to evaluate whether variant meso-Rex bypass with transposition of abdominal autogenous vein can be used as an alternative treatment modality for selected patients with symptomatic extrahepatic portal vein obstruction. For the management of idiopathic extrahepatic portal vein obstruction (EHPVO), the meso-Rex bypass (MRB) restores portal inflow to the liver by inserting a venous conduit between a splanchnic vein and the intrahepatic left portal vein (PV) branch in the Rex fossa. This procedure was initially indicated for the treatment of extrahepatic PV thrombosis following liver transplantation in children, but has been successfully used to treat non-transplant patients with thrombosis caused by other etiologies [1,2,3,4,5]. The aim of this study was to evaluate whether variant MRB with transposition of abdominal autogenous vein is a safe and effective treatment modality in selected patients with symptomatic EHPVO who are refractory to conservative management.
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