Meso-Rex bypass for extrahepatic portal vein obstruction in children

Guérin, Florent; Bidault, V.; Gonzalès, Emmanuel; Franchi‐Abella, Stéphanie; Lambert, Gary; Branchereau, Sophie

doi:10.1002/bjs.9287

Cited by 50 publications

(36 citation statements)

References 14 publications

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“…Success of the variant MRB was defined as shunt patency at 6-month follow-up, as assessed by Doppler ultrasonography with visualization of the shunt without stenosis [ 4 ]. If a patient had a repeat intervention that was successful in dilating a stenosed or thrombosed shunt, the variant MRB procedure was considered a success.…”

Section: Methodsmentioning

confidence: 99%

Variant meso-Rex bypass with transposition of abdominal autogenous vein for the management of idiopathic extrahepatic portal vein obstruction: a retrospective observational study

Kim

et al. 2015

BMC Surg

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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.

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Section: Methodsmentioning

confidence: 99%

Variant meso-Rex bypass with transposition of abdominal autogenous vein for the management of idiopathic extrahepatic portal vein obstruction: a retrospective observational study

Kim

et al. 2015

BMC Surg

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“…В исследовании Guerin F., в серии пациентов в 6 случаях из 9 при непроходимости МПШ были выполнены повторные вмешательства (3 портосистемных шунта и 3 повторных МПШ). Однако в 4 наблюдениях из 6 отмечены рецидивы кровотечений [15]. Luoto T. приводит свои наблюдения из 2 случаев повторных вмешательств при непроходимости МПШ -у обоих пациентов выполнена операция дистального спленоренального анастомоза (ДСРА) [16].…”

Section: View Following Anastomosis Division Between the Left Brancunclassified

Mesoportal shunt reconstruction in a 10-year-old child with extrahepatic portal hypertension

Razumovsky¹,

Разумовский²,

Mitupov³

et al. 2020

Rossijskij vestnik detskoj hirurgii, anesteziologii i reanimato

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Резюме Цель. Основная задача лечения детей с внепеченочной портальной гипертензией (ВПГ)-профилактика кровотечений из варикозно расширенных вен пищевода и желудка. Материалы и методы. Операция мезопортального шунтирования не только предотвращает кровотечения из варикозных вен, но восстанавливает нормальные анатомо-физиологические отношения в бассейне воротной вены. В ДГКБ № 13 им. Н. Ф. Филатова к настоящему времени накоплен самый большой в стране опыт лечения пациентов с ВПГ. С 1989 по 2017 годы мы наблюдали 789 больных с портальной гипертензией в возрасте от 2,5 месяцев до 17 лет, 23,5% которых составили дети младше 3 лет. С 2000 года мезопортальное шунтирование выполнено у 261 ребенка. У 239 (91,6%) больных достигнут отличный результат-редукция варикозных вен и восстановлена портальная перфузия печени. Обсуждение. Представлено клиническое наблюдение ребенка 9 лет с диагнозом: внепеченочная портальная гипертензия. Девочке было выполнено мезопортальное шунтирование. Однако в послеоперационном периоде отсутствовала редукция варикозных вен пищевода. Ангиографическое исследование выявило стеноз мезопортального шунта. Ребенок был оперирован повторно: выявлен стеноз мезопортального шунта, выполнена резекция суженного участка с последующим восстановлением проходимости сосудистой вставки. В послеоперационном периоде отмечалось полное исчезновение варикозных вен. Выводы. Представленный клинический пример отражает современные возможности хирургии портальной гипертензии у детей в даже таких сложных ситуациях, как стеноз сосудистого венозного анастомоза, возникающий примерно в 10% случаев после МПШ.

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“…24 Patency rates of MRB range from 60 to 90%, which are lower when compared with PSS. 36,[68][69][70] A favorable intrahepatic portal vein system translates to a greater chance of successful MRB. 71 Additionally, identification of portosystemic collaterals becomes important during surgical planning as they should be ligated during the procedure if they significantly impair portal flow.…”

Section: Role Of Surgical Shunts In Pediatric Patientsmentioning

confidence: 99%

Surgical Portosystemic Shunts: History, Evolution, and Current Applications

López‐Verdugo

Sánchez-García

Gagnon

et al. 2020

Digestive Disease Interventions

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AbstractMechanical obstruction, thrombus, intrinsic liver disease causing fibrosis or cirrhosis, or an outflow obstruction at the level of the sinusoids or hepatic venous obstruction can cause an increase in pressure or resistance, or both, leading to portal hypertension (PH). Portosystemic shunts (PSS) are usually performed to relieve the congestion that inevitably occurs in the setting of PH. Since their introduction, surgical PSS were often the treatment of choice to prevent recurrent bleeding in patients with clinically significant PH. Development of novel pharmacological therapies, continuous improvement of endoscopic approaches, the introduction of transjugular intrahepatic portosystemic shunt, and advancements in transplantation has provided an evolution in the approach for PH and has precipitated the steady decrease in the proportion of patients needing surgical shunts. Despite this, PSS remain important tools in the surgeon's armamentarium, as they are often employed in the pediatric population with extrahepatic portal vein obstruction and are frequently being used for portal inflow modulation to achieve better portal hemodynamics in resections and transplantation. This has become of great relevance to decrease the risk of small-for-size syndrome and portal hyperperfusion in liver transplantation, and to decrease the risk of posthepatectomy liver dysfunction after major resections in hepatobiliary surgery.

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Meso-Rex bypass for extrahepatic portal vein obstruction in children

Abstract: Prophylactic MRB seems a good treatment option for EHPVO in children, but should be done only by an experienced team in patients with favourable imaging and without a previous history of NUC.

Cited by 50 publications

References 14 publications

Variant meso-Rex bypass with transposition of abdominal autogenous vein for the management of idiopathic extrahepatic portal vein obstruction: a retrospective observational study

Variant meso-Rex bypass with transposition of abdominal autogenous vein for the management of idiopathic extrahepatic portal vein obstruction: a retrospective observational study

Mesoportal shunt reconstruction in a 10-year-old child with extrahepatic portal hypertension

Surgical Portosystemic Shunts: History, Evolution, and Current Applications

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