Surgical Management of Extrahepatic Portal Vein Obstruction in Children: Advantages of Meso-Rex Shunt Compared with Distal Spleno-Renal Shunt

PURPOSE To review surgical management of extrahepatic portal vein obstruction (EHPVO) at Red Cross War Memorial Children’s Hospital and compare Meso-Rex shunt (MRS) with distal splenorenal shunt (DSRS). METHODS A single-centre retrospective review documenting pre- and post-operative data in 21 children. Twenty-two shunts performed, 15 MRS and 7 DSRS over 18-year period. Patients were followed up for a mean of 11 years (range: 2–18). Data analysis included demographics, albumin, prothrombin time (PT), partial thromboplastin time (PTT), International normalized ratio (INR), fibrinogen, total bilirubin, liver enzymes and platelets before the operation and 2-years after shunt surgery. RESULTS One MRS thrombosed immediately post-surgery and the child was salvaged with DSRS. Variceal bleeding was controlled in both groups. Significant improvements were seen amongst MRS cohort in serum albumin, PT, PTT, and platelets and there was a mild improvement in serum fibrinogen. The DSRS cohort showed only a significant improvement in the platelet count. Neonatal umbilic vein catheterization (UVC) was a major risk for Rex vein obliteration. CONCLUSION In EHPVO, MRS is superior to DSRS and improves liver synthetic function. DSRS does control variceal bleeding but should only be considered when MRS is not technically feasible or as a salvage procedure when MRS fails.