The effectiveness of alternative vessel grafts for meso-rex bypass in the treatment of extrahepatic portal vein obstruction in children
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In brief
In brief
This study compares alternative autologous vessel grafts for Meso-Rex bypass versus distal splenorenal shunt in treating extrahepatic portal vein obstruction in children. Results show both procedures effectively resolve variceal bleeding and hypersplenism, with MRB demonstrating superior ammonia reduction post-operatively.
- Alternative autologous vessel grafts are effective for Meso-Rex bypass in pediatric EHPVO, offering physiologic portal flow restoration.
- MRB patients showed significant ammonia level reduction post-op, while DSRS patients experienced increased ammonia levels.
- Gastric coronary vein grafts carry higher thrombosis risk; careful graft selection is critical for MRB success.
- MRB is preferred for younger children with variceal bleeding; DSRS remains viable when MRB is anatomically unfeasible.
- Both procedures effectively resolve variceal bleeding and hypersplenism in pediatric portal hypertension.
Written by the GCMD Library team from the article.
Abstract
Purpose
This study aims to evaluate the effectiveness of alternative autologous vessel grafts in creating a Meso-Rex bypass (MRB) compared to the distal splenorenal shunt (DSRS) in resolving symptoms of portal hypertension in children.
Methods
All children with EHPVO evaluated for surgery at Siriraj Hospital from January 2011 to December 2023 were reviewed. Alternative autologous vessel grafts were used in all cases where MRB was feasible. DSRS was performed in patients for whom MRB was not possible. Baseline characteristics and outcomes were compared between the two groups.
Results
Eight children underwent successful MRB with alternative autologous vessel grafts, while six required DSRS. Children in the modified MRB group were significantly younger, with upper gastrointestinal bleeding the most common presenting symptom. In contrast, children in the DSRS group had significantly lower preoperative ammonia levels and platelet counts, with hypersplenism being the most common presenting symptom. All patients experienced complete relief of variceal bleeding and hypersplenism post-surgery. Complicated shunt thrombosis occurred after MRB using the gastric coronary vein graft. A significant decrease in ammonia levels was observed after MRB, whereas levels increased after DSRS.
Conclusion
Alternative autologous vessel grafts are effective for constructing the MRB to resolve portal hypertension compared to DSRS.