Results of the mesoportal bypass (Rex shunt) in the treatment of idiopathic extrahepatic portal vein obstruction in children

BACKGROUND: Extrahepatic portal vein obstruction (EPVO) is the principal cause of portal hypertension in children. The objective of this study was to analyze the capacity of the surgical technique that creates a mesoportal shunt to treat changes caused by EPVO. MATERIAL Y METODOS: Revision retrospectiva de los pacientes con TPEH idiopatica sometidos al shunt mesoportal y analisis de los cambios en la cifra de leucocitos, plaquetas, tiempo de protrombina y tamano del bazo al ano de la cirugia. RESULTS: Twelve patients underwent surgery, out of which 10 had prior leukopenia, 11 thrombopenia, 9 longer prothrombin times and all had hypersplenism. One patient suffered a postoperative shunt thrombosis, was reoperated and underwent a change in the operative technique. The remaining patients (92%) have functioning shunts 4.3 ± 2.5 years after surgery, and none have suffered any episode of gastrointestinal bleeding. One year after surgery, there were significant changes in the number of platelets, prothrombin time and spleen size, with no significant changes in the number of leukocytes. However, the number of patients who went from a leukopenic to a normal state was significant, as happened with changes in prothrombin time. CONCLUSIONES: El shunt mesoportal de Rex mejora de manera efectiva las alteraciones asociadas a la hipertension portal por TPEH, con una alta tasa de exito, por lo que deberia ser la tecnica de eleccion en estos pacientes.