Rao Sanjay, Zameer M M, Pallav K, Rakhesh M, Chandrashekar Vinay, D'Cruz Ashley
Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India.
J Indian Assoc Pediatr Surg. 2025 May-Jun;30(3):351-355. doi: 10.4103/jiaps.jiaps_305_24. Epub 2025 Mar 3.
The Meso-Rex bypass (MRB) provides a physiological cure for EHPVO by restoring hepatopetal flow, effectively reducing portal pressure. We share our experience with the MRB procedure, its outcomes, and challenges.
To describe the feasibility and effectiveness of MRB in children with EHPVO in our practice.
This is a retrospective study of children with EHPVO who underwent MRB between January 2013 and May 2024. MRB was considered in patients with asymptomatic splenomegaly, moderate hypersplenism, and patent left portal vein either on Doppler or contrast-enhanced computed tomography. The internal jugular vein was used in all cases as jump graft. At follow-up, Doppler was done to note the patency of the shunt and size of the spleen.
Eighty-two shunts of all types were performed. MRB was considered in 17 patients (21%) as per preoperative criteria. MRB was possible in only 10 (12%). Data were analyzed for these 10 children. The average age was 4.5 years (range 1-11 years), 7 were <5 years. Presentation included hematemesis (eight children) and splenomegaly (two children). Four had moderate hypersplenism. Two developed transient self-limiting ascites in early postoperative period. There were no other immediate perioperative complications. The average duration of follow-up was 67 months. One child had hematemesis 2 years after surgery due to stenosis at the proximal end of graft which was treated with endovascular dilatation. Hypersplenism resolved in all children.
MRB is the only curative option for EHPVO. It is feasible in a small subset of patients. Outcomes of MRB are good, especially in younger children.
中肠系膜-肝静脉分流术（MRB）通过恢复向肝血流，有效降低门静脉压力，为肝外门静脉阻塞（EHPVO）提供了一种生理性治疗方法。我们分享我们在MRB手术方面的经验、其结果及挑战。
描述在我们的实践中MRB治疗EHPVO患儿的可行性和有效性。
这是一项对2013年1月至2024年5月期间接受MRB治疗的EHPVO患儿的回顾性研究。对于无症状脾肿大、中度脾功能亢进且经多普勒或增强CT显示左门静脉通畅的患者，考虑行MRB。所有病例均使用颈内静脉作为搭桥血管。随访时，进行多普勒检查以记录分流血管的通畅情况及脾脏大小。
共进行了82例各种类型的分流手术。根据术前标准，17例患者（21%）被考虑行MRB。仅10例（12%）可行MRB。对这10例患儿的数据进行了分析。平均年龄为4.5岁（范围1 - 11岁），7例年龄小于5岁。临床表现包括呕血（8例患儿）和脾肿大（2例患儿）。4例有中度脾功能亢进。2例在术后早期出现短暂的自限性腹水。无其他围手术期即刻并发症。平均随访时间为67个月。1例患儿术后2年因移植血管近端狭窄出现呕血，经血管内扩张治疗。所有患儿的脾功能亢进均得到缓解。
MRB是EHPVO唯一的治愈性选择。在一小部分患者中可行。MRB的效果良好，尤其是在年幼儿童中。
