Effectiveness of Rex shunt in the treatment of portal hypertension

BackgroundChildren with portal venous thrombosis often have severe symptoms secondary to portal hypertension including recurrent upper gastrointestinal (UGI) bleeds and hypersplenism. We report results of the use of the mesenterico–left portal bypass (Rex shunt) in 5 consecutive patients.MethodsA retrospective chart review of all patients with portal venous thrombosis who underwent Rex shunt procedure was performed. Children were evaluated preoperatively with magnetic resonance angiogram, Doppler ultrasound, and mesenteric angiogram. Postoperative ultrasounds were performed in follow-up.ResultsAll patients had evidence of portal hypertension and hypersplenism. The average age of the patients was 13.2 ± 4.9 (7-19) years. The patient had an average of 2.6 ± 1.7 UGI bleeds requiring banding and 3.4 ± 4.2 U of blood transfused before undergoing the shunt. The mean operative time was 383 ± 46 minutes, and length of stay was 10.4 ± 7.1 days. In follow-up of 18.8 ± 5.2 months (11-24 months), all but 1 patient had a patent shunt. One narrowed shunt was successfully dilated by percutaneous angioplasty. Thrombocytopenia improved significantly in patients with functioning shunts but did not correlate with a significant decrease in splenic size.ConclusionsThe Rex shunt reestablishes normal hepatopedal portal flow, and in patients with functioning shunts, no recurrent UGI bleeds or transfusions were required or evidence of encephalopathy were noted.