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

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

Research output: Contribution to journalArticleResearchpeer-review

5 Citations (Scopus)

Abstract

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. 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). Results The spleen-preserving spleno-Rex bypass was successfully performed in all 4 patients. The median operative time was 225 min (range: 215-260 min). One patient received blood transfusion, and the postoperative length of hospital stay varied from 4 to 6 days (median: 4.5 days). Intraoperative portal venous angiography demonstrated the patency of the shunt in all patients. Postoperatively, the complete blood count normalized and the biochemistry tests were within normal range. Postoperative ultrasound confirmed shunt patency and satisfactory flow in the proximal splenic-portal shunt in each patient. The size of the spleen decreased and there was no recurrence of variceal bleeding. Conclusions The spleen-preserving spleno-Rex bypass is a viable option to treat EHPVO in children.

Original languageEnglish
Pages (from-to)1072-1075
Number of pages4
JournalJournal of Pediatric Surgery
Volume50
Issue number6
DOIs
Publication statusPublished - 1 Jun 2015

Keywords

  • Children
  • Extra-hepatic portal hypertension
  • Rex shunt
  • Spleno-Rex bypass

Cite this

Zhang, Jin-Shan ; Li, Long ; Hou, Wen Ying ; Liu, Shu-Li ; Diao, Mei ; Zhang, Jun ; Li, Qi ; Ye, Mao ; Ming, An-Xiao ; Dong, Ning ; Cheng, Wei. / Spleen-preserving proximal splenic-left intrahepatic portal shunt for the treatment of extrahepatic portal hypertension in children. In: Journal of Pediatric Surgery. 2015 ; Vol. 50, No. 6. pp. 1072-1075.
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title = "Spleen-preserving proximal splenic-left intrahepatic portal shunt for the treatment of extrahepatic portal hypertension in children",
abstract = "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. 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). Results The spleen-preserving spleno-Rex bypass was successfully performed in all 4 patients. The median operative time was 225 min (range: 215-260 min). One patient received blood transfusion, and the postoperative length of hospital stay varied from 4 to 6 days (median: 4.5 days). Intraoperative portal venous angiography demonstrated the patency of the shunt in all patients. Postoperatively, the complete blood count normalized and the biochemistry tests were within normal range. Postoperative ultrasound confirmed shunt patency and satisfactory flow in the proximal splenic-portal shunt in each patient. The size of the spleen decreased and there was no recurrence of variceal bleeding. Conclusions The spleen-preserving spleno-Rex bypass is a viable option to treat EHPVO in children.",
keywords = "Children, Extra-hepatic portal hypertension, Rex shunt, Spleno-Rex bypass",
author = "Jin-Shan Zhang and Long Li and Hou, {Wen Ying} and Shu-Li Liu and Mei Diao and Jun Zhang and Qi Li and Mao Ye and An-Xiao Ming and Ning Dong and Wei Cheng",
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Zhang, J-S, Li, L, Hou, WY, Liu, S-L, Diao, M, Zhang, J, Li, Q, Ye, M, Ming, A-X, Dong, N & Cheng, W 2015, 'Spleen-preserving proximal splenic-left intrahepatic portal shunt for the treatment of extrahepatic portal hypertension in children', Journal of Pediatric Surgery, vol. 50, no. 6, pp. 1072-1075. https://doi.org/10.1016/j.jpedsurg.2015.02.048

Spleen-preserving proximal splenic-left intrahepatic portal shunt for the treatment of extrahepatic portal hypertension in children. / Zhang, Jin-Shan; Li, Long; Hou, Wen Ying; Liu, Shu-Li; Diao, Mei; Zhang, Jun; Li, Qi; Ye, Mao; Ming, An-Xiao; Dong, Ning; Cheng, Wei.

In: Journal of Pediatric Surgery, Vol. 50, No. 6, 01.06.2015, p. 1072-1075.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Spleen-preserving proximal splenic-left intrahepatic portal shunt for the treatment of extrahepatic portal hypertension in children

AU - Zhang, Jin-Shan

AU - Li, Long

AU - Hou, Wen Ying

AU - Liu, Shu-Li

AU - Diao, Mei

AU - Zhang, Jun

AU - Li, Qi

AU - Ye, Mao

AU - Ming, An-Xiao

AU - Dong, Ning

AU - Cheng, Wei

PY - 2015/6/1

Y1 - 2015/6/1

N2 - 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. 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). Results The spleen-preserving spleno-Rex bypass was successfully performed in all 4 patients. The median operative time was 225 min (range: 215-260 min). One patient received blood transfusion, and the postoperative length of hospital stay varied from 4 to 6 days (median: 4.5 days). Intraoperative portal venous angiography demonstrated the patency of the shunt in all patients. Postoperatively, the complete blood count normalized and the biochemistry tests were within normal range. Postoperative ultrasound confirmed shunt patency and satisfactory flow in the proximal splenic-portal shunt in each patient. The size of the spleen decreased and there was no recurrence of variceal bleeding. Conclusions The spleen-preserving spleno-Rex bypass is a viable option to treat EHPVO in children.

AB - 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. 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). Results The spleen-preserving spleno-Rex bypass was successfully performed in all 4 patients. The median operative time was 225 min (range: 215-260 min). One patient received blood transfusion, and the postoperative length of hospital stay varied from 4 to 6 days (median: 4.5 days). Intraoperative portal venous angiography demonstrated the patency of the shunt in all patients. Postoperatively, the complete blood count normalized and the biochemistry tests were within normal range. Postoperative ultrasound confirmed shunt patency and satisfactory flow in the proximal splenic-portal shunt in each patient. The size of the spleen decreased and there was no recurrence of variceal bleeding. Conclusions The spleen-preserving spleno-Rex bypass is a viable option to treat EHPVO in children.

KW - Children

KW - Extra-hepatic portal hypertension

KW - Rex shunt

KW - Spleno-Rex bypass

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DO - 10.1016/j.jpedsurg.2015.02.048

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