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rex shunt

Jin-Shan Zhang, Long Li, Wei Cheng
No abstract text is available yet for this article.
June 2016: Journal of the American College of Surgeons
Tae-Yong Ha, Kyung-Mo Kim, Gi-Young Ko, Seak Hee Oh, Tae-Won Kwon, Yong-Pil Cho, Sung-Gyu Lee
BACKGROUND: 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. METHODS: This 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...
2015: BMC Surgery
Gloria Chocarro, Paloma Triana Junco, Eva Dominguez, María Virginia Amesty, Vanesa Nuñez Cerezo, Francisco Hernandez, Javier Murcia, Juan Antonio Tovar, Manuel Lopez Santamaria
OBJECTIVE: The mesoportal shunt (MPS) and liver transplantation (LT) have changed the scenario of extrahepatic portal vein obstruction (EHPVO) since the MPS, the only "curative" technique, can now be offered in asymptomatic patients and also thrombotic complications of LT have increased the incidence of EHPVO. MATERIAL AND METHODS: A retrospective study of patients undergoing surgery for EHPVO was conducted between 1990 and 2015. An analysis was done for the shunt permeability and clinical evolution over time...
February 2016: European Journal of Pediatric Surgery
Jin-Shan Zhang, Long Li, Wen-Ying Hou, Shu-Li Liu, Mei Diao, Jun Zhang, Qi Li, Mao Ye, An-Xiao Ming, Ning Dong, Wei Cheng
PURPOSE: The Rex shunt has been employed successfully to treat patients with extrahepatic portal hypertension. In the conventional Rex shunt, the internal jugular vein is used as a venous graft. Inevitably, such a procedure requires neck exploration and sacrifice of the internal jugular vein. The authors describe a novel adaptation of spleen-preserving spleno-Rex bypass, successfully carried out in children with extrahepatic portal hypertension. METHODS: The mean age of the four patients (1 boy, 3 girls) was 46 months at the time of operation...
June 2015: Journal of Pediatric Surgery
Fabrizio di Francesco, Lidia Monti, Chiara Grimaldi, Cristina Lo Zupone, Arianna Bertocchini, Jean de Ville de Goyet
A cavernomatous transformation of the extrahepatic portion of the portal vein is a common cause of chronic portal hypertension in children. A few attempts at radiological interventions have been reported, but have rarely been successful. In this report, a surgical Meso-Rex bypass was performed to treat complicated prehepatic portal hypertension, after the insertion of an intrahepatic stent for portosystemic shunting had failed. The review of this case nicely illustrates how differently effective are these two shunting procedures-in terms of restoring hepatopetal flow, managing portal hypertension, and establishing-or not-portosystemic connections...
January 2015: Pediatric Surgery International
Zhang Wei, Shao Guang Rui, Zhang Yuan, Li Dian Guo, Liu Qian, Liu Shu Wei
BACKGROUND: Meso-Rex bypass (MRB) surgery is being increasingly used to treat chronic prehepatic portal hypertension secondary to extrahepatic portal vein thrombosis (EPVT) and cavernous transformation (EPVCT) in children. Rather than using the internal jugular vein (IJV, the traditional venous graft), we used an autogenous splenic vein segment graft for MRB. MATERIAL/METHODS: We examined 25 children with extrahepatic portal hypertension and a history of recurrent upper gastrointestinal (GI) variceal bleeding despite previous endoscopic sclerotherapy...
2014: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Arianna Bertocchini, Pierluigi Falappa, Chiara Grimaldi, Giuseppe Bolla, Lidia Monti, Jean de Ville de Goyet
BACKGROUND: Children with extrahepatic portal hypertension typically present with cavernomatous transformation of the portal vein and a poorly defined intrahepatic portal vein system on conventional imaging. With the Meso-Rex Bypass becoming the gold-standard intervention for a cure, a precise assessment of the intrahepatic portal vein system provides helpful data for deciding whether a Meso-Rex Bypass is feasible or not. METHODS: All children with extrahepatic portal hypertension were prospectively assessed by wedged hepatic venous portography...
August 2014: Journal of Pediatric Surgery
Yong-Pil Cho, Tae-Yong Ha, Gi-Young Ko, Kyung-Mo Kim, Sung-Gyu Lee
The meso-Rex shunt is used to safely and effectively treat patients with portal hypertension due to extrahepatic portal vein obstruction. In the standard meso-Rex shunt technique, the patient's own internal jugular vein is used as a vascular autograft. Inevitably, such a procedure requires neck exploration and sacrifice of the internal jugular vein. Here, we present a case of a 20-year-old man with idiopathic extrahepatic portal vein obstruction, who was treated with a new technique of transposition of the coronary vein, which is enlarged in most cases of portal hypertension, as an alternative to the standard meso-Rex shunt technique...
February 2014: Annals of Surgical Treatment and Research
Yuji Soejima, Ken Shirabe, Tomoharu Yoshizumi, Hideaki Uchiyama, Toru Ikegami, Yo-Ichi Yamashita, Tetsuo Ikeda, Hirofumi Kawanaka, Keishi Sugimachi, Koshi Mimori, Masayuki Watanabe, Masaru Morita, Eiji Oki, Hiroshi Saeki, Yoshihiko Maehara
Portal vein thrombosis (PVT) after liver transplantation is a relatively common but serious complication which could lead to portal hypertension or a direct graft loss. A "Rex" shunt created between the superior mesenteric vein (SMV) and the umbilical portion of the left portal vein can be a useful option to treat PVT after pediatric liver transplantation, however, its application to adult patients has not been reported so far because appropriate vein grafts are hardly available. Herein we present a case of PVT after left lobe living donor liver transplantation (LDLT) who underwent the procedure using the own inferior jugular vein and the gonadal vein as a shunt graft...
November 2013: Fukuoka Igaku Zasshi, Hukuoka Acta Medica
Yong-Pil Cho, Kyung-Mo Kim, Tae-Yong Ha, Gi-Young Ko, Jae-Yeon Hwang, Hojong Park, Young Soo Chung, Taein Yoon, Shin Hwang, Heungman Jun, Tae-Won Kwon, Sung-Gyu Lee
The purpose of this study was to evaluate retrospectively the results of PTA for late-onset PV complications after pediatric LDLT and to assess whether a meso-Rex shunt is a viable option for treating restenosis of the PV after PTA in selected cases. Seventy-five children who underwent adult-to-child LDLT were included in this study, and there were six late-onset PV complications (8.0%). The initial therapeutic approach was PTA, with or without stent: PTA with balloon dilation for three children, PTA with stent placement for one child, and failure to cannulate the occluded PV for two children...
February 2014: Pediatric Transplantation
Fabrizio di Francesco, Chiara Grimaldi, Jean de Ville de Goyet
No abstract text is available yet for this article.
February 2014: Journal of the American College of Surgeons
S Sebastiani, T Martens, C Randon, A de Jaeger, R De Bruyne, D Voet, R I Troisi
The Meso-Rex shunt (MRS) procedure was first described in 1992 by de VILLE et al. for the treatment of extrahepatic portal vein obstruction (EHPVO) in paediatric liver transplant patients. This technique provides more physiological relief of portal hypertension compared to the porto-systemic shunts, which can lead to long-term complications such as hyperammonaemia and hepato-pulmonary syndrome. Different conduits as autologous and cryopreserved veins or prosthetic grafts have been previously reported. We present herein the first case of a MRS using the autologous deep femoral vein in a 17-year-old female patient affected by EHPVO from unknown reasons...
September 2013: Acta Chirurgica Belgica
F Guérin, V Bidault, E Gonzales, S Franchi-Abella, G De Lambert, S Branchereau
BACKGROUND: Meso-Rex bypass (MRB) and portosystemic surgical shunt (PSS) are both used to treat extrahepatic portal vein obstruction (EHPVO) in children. The aim of this study was to analyse the outcome of MRB and PSS to select patients who could benefit from a prophylactic MRB. METHODS: This single-centre retrospective study of children who underwent either MRB or PSS for EHPVO was conducted between 1996 and 2010. Details of patient demographics and preoperative evaluation were collected...
November 2013: British Journal of Surgery
Seung Jin Kim, Kyung Mo Kim
Variceal bleeding results in significant morbidity and mortality in both children and adults. The guidelines for the management of variceal bleeding are well established in adults but not in children as there have been insufficient pediatric studies of this disorder. In addition, the adult guidelines for treatment of variceal bleeding cannot be applied directly to children as the etiology and natural course of this disease differs between children and adults. Examples of recommended treatments in children include endoscopic variceal ligation as secondary prophylaxis for biliary atresia whereas a meso-Rex shunt operation for extrahepatic portal vein obstruction...
March 2013: Pediatric Gastroenterology, Hepatology & Nutrition
Rajeev Khanna, Shiv K Sarin
NCPH is a heterogeneous group of liver disorders of vascular origin, leading to PHT with near normal HVPG. NCPF/IPH is a disorder of young adults or middle aged women, whereas EHPVO is a disorder of childhood. Early age acute or recurrent infections in an individual with thrombotic predisposition constitute the likely pathogenesis. Both disorders present with clinically significant PHT with preserved liver functions. Diagnosis is easy and can often be made clinically with support from imaging modalities. Management centers on control and prophylaxis of variceal bleeding...
February 2014: Journal of Hepatology
Daniele Alberti, Mara Colusso, Maurizio Cheli, Paolo Ravelli, Amedeo Indriolo, Sergio Signorelli, Stefano Fagiuoli, Lorenzo D'Antiga
BACKGROUND: The management of extrahepatic portal vein obstruction (EHPVO) in children is controversial. We report our experience with a prospective evaluation of a stepwise protocol based on severity of portal hypertension and feasibility of mesoportal bypass (MPB). METHODS: After diagnosis, children with EHPVO underwent surveillance endoscopies and received nonselective β-blockers (NSBBs) or endoscopic variceal obliteration (EVO) when large varices were detected...
November 2013: Journal of Pediatric Gastroenterology and Nutrition
Simon C Ling
Portal hypertension commonly accompanies advanced liver disease and gives rise to severe and life-threatening complications, including hemorrhage from esophageal varices. Diagnosis of portal hypertension in children currently relies on finding evidence of splenomegaly and the formation of portosystemic collaterals. There is a paucity of pediatric data to support the use of primary prophylaxis against variceal hemorrhage. A combination of vasoactive drug and endoscopic therapy should be used to manage variceal bleeding...
November 2012: Seminars in Liver Disease
Rukhmi Bhat, Timothy B Lautz, Riccardo A Superina, Robert Liem
BACKGROUND/PURPOSE: Extrahepatic portal vein obstruction (EHPVO) is an important cause of chronic portal hypertension in children. Although usually idiopathic in etiology, genetic and acquired thrombophilia have been implicated in EHPVO. Meso-Rex bypass is increasingly used to treat EHPVO in children. OBJECTIVE: The objective of this study is to assess the relationship of postoperative anticoagulation strategies and thrombophilic risk factors to the development of bypass thrombosis following the meso-Rex bypass...
May 2013: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Timothy B Lautz, Lisa A Keys, Joseph C Melvin, Joy Ito, Riccardo A Superina
BACKGROUND: Consequences of extrahepatic portal vein obstruction (EHPVO) include variceal bleeding and hypersplenism due to portal hypertension, as well as metabolic abnormalities secondary to impaired portal venous circulation. The purpose of this study was to compare the effectiveness of meso-Rex bypass and portosystemic shunt (PSS) for reversing these symptoms in children with EHPVO. STUDY DESIGN: All children with idiopathic EHPVO evaluated for potential meso-Rex bypass at a single institution between 1997 and 2010 were reviewed...
January 2013: Journal of the American College of Surgeons
Dominik Ketelsen, Steven W Warmann, Juergen F Schaefer, Peter Haber, Joerg Fuchs, Claus D Claussen, Klaus Brechtel
Extrahepatic portal vein (PV) obstruction (EHPVO) is a rare disorder in early childhood with unknown incidence and mostly unknown etiology. In children with EHPVO, the hepatopedal flow of the mesenteric venous blood is hindered by an obstruction of the PV resulting in prehepatic portal hypertension. The curative treatment with a meso-Rex shunt connects the superior mesenteric vein to the left PV by a venous autograft. Despite good primary patency, reocclusion of a meso-Rex bypass and its treatment can be challenging...
September 2012: Journal of Pediatric Surgery
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