17 OUTCOMES OF MESOPORTAL BYPASS FOR EXTRAHEPATIC PORTAL VEIN OBSTRUCTION EXTENDING INTO ADULTHOOD
Topi Luoto, Antti Koivusalo, Risto Rintala, Mikko Pakarinen
Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland

Abstract

Aim of the study: In extrahepatic portal vein obstruction (EHPVO) a successful mesoportal bypass restores physiological portal inflow. We aimed to analyze our national follow-up results of mesoportal bypass extending into adulthood.

Methods: After ethical approval charts of 29 consecutive patients (median age 7.7 years, range 2.3-27.4) with EHPVO who received Rex shunt using grafts constructed of greater saphenous veins (n=22) or internal jugular vein (n=7) between 2002 and 2017 were reviewed. All patients had hypersplenism and 15 suffered from variceal bleeding. Follow-up included abdominal ultrasound and blood count screening at 3, 6, 12 months and annually thereafter.

Main results: After median follow-up of 8.5 (range 0.02-15.2) years 21 patients (72%) had patent rex shunt without variceal bleeding and with resolution of hypersplenism. Three patients (10%) developed rex-anastomosis stenosis 0.7 (0.2-1.9) years postoperatively which was corrected by surgery (n=2) or stenting (n=1). Eight patients (28%) developed permanent shunt occlusion 0.7 years (1 day-4.3 years) after surgery. Two of them had undergone previous surgery for portal hypertension. Attempts to restore shunt patency by surgery (n=3) were unsuccessful and four patients have subsequently received splenorenal shunt. Previous surgery for portal hypertension (2/8 vs 6/27, p=0.07), smaller preoperative spleen size (10.4 (8.0-12.5) vs 14.0 (7.3-20) cm, p=0.06) and higher preoperative platelet levels (119 (50-358) vs 91 (36-162) E9/L, p=0.09) tended to associate with shunt occlusion. Patency of the IJV and saphenous vein grafts was similar (71% vs 73%). Cumulative graft patency at 6 months, 1 year, 3 years, 5 years, and 10 years was 86%, 82%, 75%, 70%, and 70%, respectively (Fig.1).

Conclusion: A successful mesoportal bypass cures portal hypertension in EHPVO and the benefits are long-lasting in the majority of patients. Revision of shunt thrombosis is challenging and often necessitates alternative shunt surgery.

 


Website
Yes