The effectiveness of alternative vessel grafts for meso-rex bypass in the treatment of extrahepatic portal vein obstruction in children

Abstract

Purpose: This study aims to evaluate the effectiveness of alternative autologous vessel grafts in creating a Meso-Rex bypass (MRB) compared to the distal splenorenal shunt (DSRS) in resolving symptoms of portal hypertension in children. Methods: All children with EHPVO evaluated for surgery at Siriraj Hospital from January 2011 to December 2023 were reviewed. Alternative autologous vessel grafts were used in all cases where MRB was feasible. DSRS was performed in patients for whom MRB was not possible. Baseline characteristics and outcomes were compared between the two groups. Results: Eight children underwent successful MRB with alternative autologous vessel grafts, while six required DSRS. Children in the modified MRB group were significantly younger, with upper gastrointestinal bleeding the most common presenting symptom. In contrast, children in the DSRS group had significantly lower preoperative ammonia levels and platelet counts, with hypersplenism being the most common presenting symptom. All patients experienced complete relief of variceal bleeding and hypersplenism post-surgery. Complicated shunt thrombosis occurred after MRB using the gastric coronary vein graft. A significant decrease in ammonia levels was observed after MRB, whereas levels increased after DSRS. Conclusion: Alternative autologous vessel grafts are effective for constructing the MRB to resolve portal hypertension compared to DSRS.