Efficacies of Rex-bypass shunt plus paraesophagogastric devascularization for prehepatic portal hypertension due to cavernomatous transformation of portal vein in children

Objective To evaluate the efficacies of Rex-bypass shunt plus paraesophagogastric devascularization for prehepatic portal hypertension (PHT) due to cavernomatous transformation of portal vein (CTPV) in children. Methods The clinical data of 21 children with prehepatic vascular hypertension undergoing Rex-bypass shunt plus paraesophagogastric devascularization were retrospectively analyzed. There were 13 males and 8 females with an age range of 3-49 years. According to age, they were divided into 3 groups after color Doppler ultrasound of portal vein system. Computed tomographic portal vein angiography (CTV), three dimensional imaging and liver function test were performed preoperatively. And the procedures were Rex-bypass shunt plus paraesophagogastric devascularization, splenectomy or subtotal splenectomy. Results There was no instance of intraoperative mortality. The follow-up period was 6-64 months. There were vascular bypass with blood flow (n=16), partial obstruction (n=1), thrombosis (n=5) and recanalization (n=2). Among 17 cases with esophageal and gastric varices, there were significant improvements, including complete remission (n=6), mild varicosity (n=8) and moderate varicosity (n=3). The results of Fisher's exact test and paired rank indicated improved hepatic function (P=0.042). Four-table Pearson's Chi-square test indicated better efficacies of early over delayed operation. Conclusions Rex-bypass shunt plus pericardial devascularization is both safe and efficacious for prehepatic portal hypertension due to CTPV in children. Key words: Portal hypertension; Cardia; Portal vein