The optimal procedure of modified Rex shunt for the treatment of extrahepatic portal hypertension in children.

OBJECTIVE: Since 2008, the modified Rex shunt has been used for the treatment of extrahepatic portal venous obstruction (EHPVO) in our center, and satisfactory results were initially achieved. However, the postoperative recurrence rate gradually increased. We therefore performed a retrospective study to evaluate the outcome and identify the optimal procedure.

METHODS: Between October 2008 and March 2016, 79 children with EHPVO underwent the Rex shunt in our hospital: 48 underwent the gastroportal shunt (GP), 26 underwent the portal cavernoma-Rex shunt with interposition of grafted portal vessel (PP), and 5 underwent a spleen-preserving splenoportal bypass (SP). The results of these three types of operation were compared.

RESULTS: The portal pressure and splenic size were significantly reduced after surgery (P < .05). The levels of platelet and hemoglobin were significantly increased after surgery (P < .05). The operative time in the GP group was significantly longer than in the PP group (P = .045). The diameter of the bypass vein was significantly larger in the GP group than in the PP group (P = .029). Postoperative rebleeding occurred in 19%: 22.9% (11 of 48) in the GP group, 11.5% (3 of 26) in PP group, and 20% (1 of 5) in the SP group. There was no significant difference in the splenic size, postoperative portal pressure, hospital stay, blood flow velocity, or hemoglobin among the three groups (P > .05).

CONCLUSIONS: The modified Rex shunt is an effective treatment of EHPVO in children, and we believe that the PP procedure is the most suitable modified Rex shunt in our center.