Spleen-preserving proximal splenic-left intrahepatic portal shunt for the treatment of extrahepatic portal hypertension in children

Journal of Pediatric Surgery
Jin-Shan ZhangWei Cheng

Abstract

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. The mean age of the four patients (1 boy, 3 girls) was 46 months at the time of operation. All children had a history of upper gastrointestinal bleeding, and suffered from splenomegaly and hypersplenism. Spleen-preserving proximal splenic-left intrahepatic portal shunt was performed in all patients. The splenic artery and vein were ligated at the splenic hilum, and the splenic vein was completely separated from the bed of the pancreas to its junction with the inferior mesenteric vein. The freed splenic vein was anastomosed to left portal vein. The short gastric and left gastroepiploic vessels were kept intact to supply and drain the spleen. All patients were followed-up for 7-33 months (median: 21.5 months). The spleen-preserving spleno-Rex bypass was successfully performed in all 4 patients. Th...Continue Reading

References

May 1, 1988·Archives of Surgery·A L Warshaw
Jan 28, 2003·Journal of Pediatric Gastroenterology and Nutrition·Jörg FuchsMichael Melter
Nov 14, 2006·Pediatric Transplantation·Riccardo SuperinaJean de Ville de Goyet
Jun 15, 2007·Journal of Pediatric Surgery·Julie A QueryWilliam J Sharp
Nov 3, 2009·Journal of Hepato-biliary-pancreatic Sciences·Andrew L Warshaw
Oct 20, 2011·Journal of Pediatric Surgery·Alcides Augusto Salzedas-NettoJosé Luiz Martins
Nov 16, 2011·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·James R ButlerThomas J Howard
Jan 17, 2012·Journal of Pediatric Surgery·Jin-Shan ZhangAn-Xiao Ming
Feb 7, 2014·Digestive Diseases and Sciences·Quanda LiuNingxin Zhou

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Citations

Jul 10, 2019·Surgery·Alexander R CortezAlexander J Bondoc

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