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Partial splenectomy and use of splenic vein as an autograft for meso-Rex bypass: a clinical observational study.
Med Sci Monit. 2014 Nov 11; 20:2235-42.MS

Abstract

BACKGROUND

Meso-Rex bypass (MRB) surgery is being increasingly used to treat chronic prehepatic portal hypertension secondary to extrahepatic portal vein thrombosis (EPVT) and cavernous transformation (EPVCT) in children. Rather than using the internal jugular vein (IJV, the traditional venous graft), we used an autogenous splenic vein segment graft for MRB.

MATERIAL/METHODS

We examined 25 children with extrahepatic portal hypertension and a history of recurrent upper gastrointestinal (GI) variceal bleeding despite previous endoscopic sclerotherapy. All patients had melena, splenomegaly, hypersplenism, or some combination thereof. Left portal vein (LPV) patency was verified in 22 patients using intraoperative direct portography through the umbilical vein. Partial splenectomy was performed to enable the harvest of the splenic vein trunk, which was anastomosed between the superior mesenteric vein (SMV) and the left portal vein (LPV). All patients were followed for 12-48 months (mean=25.6 months) and no patients were lost to follow-up.

RESULTS

Preoperative Doppler ultrasound (US) imaging indicated that 18/25 patients had adequate intrahepatic portal veins for shunting, with no blood flow in the LPVs of 7 patients. LPV patency in 22/25 patients was verified using intraoperative direct portography, with successful MRB. Shunting was converted into a portosystemic shunt in the remaining 3/25 patients with thrombosed LPVs. A Doppler US evaluation of the vein conduit revealed excellent postoperative flow. The patients' mean hemoglobin, platelet, and white blood cell counts increased significantly, and in all cases the endoscopic status obviously improved after shunting. Occlusion or narrowing occurred in 2/22 patients after discharge. At 12 months (for 1 patient) and 24 months (for 1 patient), the shunt was converted into a portosystemic shunt. The cumulative graft patency rate was 91% (20/22).

CONCLUSIONS

Partial splenectomy and splenic vein autografting in MRB surgery can successfully resolve prehepatic portal hypertension and hypersplenism in children.

Authors+Show Affiliations

Department of Radiology, Second Hospital of Shandong University, Jinan, Shandong, China (mainland).Department of Radiology, Second Hospital of Shandong University, Jinan, Shandong, China (mainland).Department of Evidence-Based Medicine, Second Hospital of Shandong University, Jinan, Shandong, China (mainland).Department of Pediatric Surgery, Second Hospital of Shandong University, Jinan, Shandong, China (mainland).Department of Pediatric Surgery, Second Hospital of Shandong University, Jinan, Shandong, China (mainland).Department of Anatomy, Medical College of Shandong University, Jinan, Shandong, China (mainland).

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25384413

Citation

Wei, Zhang, et al. "Partial Splenectomy and Use of Splenic Vein as an Autograft for meso-Rex Bypass: a Clinical Observational Study." Medical Science Monitor : International Medical Journal of Experimental and Clinical Research, vol. 20, 2014, pp. 2235-42.
Wei Z, Rui SG, Yuan Z, et al. Partial splenectomy and use of splenic vein as an autograft for meso-Rex bypass: a clinical observational study. Med Sci Monit. 2014;20:2235-42.
Wei, Z., Rui, S. G., Yuan, Z., Guo, L. D., Qian, L., & Wei, L. S. (2014). Partial splenectomy and use of splenic vein as an autograft for meso-Rex bypass: a clinical observational study. Medical Science Monitor : International Medical Journal of Experimental and Clinical Research, 20, 2235-42. https://doi.org/10.12659/MSM.892482
Wei Z, et al. Partial Splenectomy and Use of Splenic Vein as an Autograft for meso-Rex Bypass: a Clinical Observational Study. Med Sci Monit. 2014 Nov 11;20:2235-42. PubMed PMID: 25384413.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Partial splenectomy and use of splenic vein as an autograft for meso-Rex bypass: a clinical observational study. AU - Wei,Zhang, AU - Rui,Shao Guang, AU - Yuan,Zhang, AU - Guo,Li Dian, AU - Qian,Liu, AU - Wei,Liu Shu, Y1 - 2014/11/11/ PY - 2014/11/12/entrez PY - 2014/11/12/pubmed PY - 2015/6/30/medline SP - 2235 EP - 42 JF - Medical science monitor : international medical journal of experimental and clinical research JO - Med Sci Monit VL - 20 N2 - BACKGROUND: Meso-Rex bypass (MRB) surgery is being increasingly used to treat chronic prehepatic portal hypertension secondary to extrahepatic portal vein thrombosis (EPVT) and cavernous transformation (EPVCT) in children. Rather than using the internal jugular vein (IJV, the traditional venous graft), we used an autogenous splenic vein segment graft for MRB. MATERIAL/METHODS: We examined 25 children with extrahepatic portal hypertension and a history of recurrent upper gastrointestinal (GI) variceal bleeding despite previous endoscopic sclerotherapy. All patients had melena, splenomegaly, hypersplenism, or some combination thereof. Left portal vein (LPV) patency was verified in 22 patients using intraoperative direct portography through the umbilical vein. Partial splenectomy was performed to enable the harvest of the splenic vein trunk, which was anastomosed between the superior mesenteric vein (SMV) and the left portal vein (LPV). All patients were followed for 12-48 months (mean=25.6 months) and no patients were lost to follow-up. RESULTS: Preoperative Doppler ultrasound (US) imaging indicated that 18/25 patients had adequate intrahepatic portal veins for shunting, with no blood flow in the LPVs of 7 patients. LPV patency in 22/25 patients was verified using intraoperative direct portography, with successful MRB. Shunting was converted into a portosystemic shunt in the remaining 3/25 patients with thrombosed LPVs. A Doppler US evaluation of the vein conduit revealed excellent postoperative flow. The patients' mean hemoglobin, platelet, and white blood cell counts increased significantly, and in all cases the endoscopic status obviously improved after shunting. Occlusion or narrowing occurred in 2/22 patients after discharge. At 12 months (for 1 patient) and 24 months (for 1 patient), the shunt was converted into a portosystemic shunt. The cumulative graft patency rate was 91% (20/22). CONCLUSIONS: Partial splenectomy and splenic vein autografting in MRB surgery can successfully resolve prehepatic portal hypertension and hypersplenism in children. SN - 1643-3750 UR - https://www.unboundmedicine.com/medline/citation/25384413/Partial_splenectomy_and_use_of_splenic_vein_as_an_autograft_for_meso_Rex_bypass:_a_clinical_observational_study_ L2 - https://www.medscimonit.com/download/index/idArt/892482 DB - PRIME DP - Unbound Medicine ER -