title: Surgical portosystemic shunts and the Rex bypass in children: a single-centre experience.
abstract: OBJECTIVE
  This study aimed to illustrate the indications for, and types and outcomes of surgical portosystemic shunt (PSS) and/or Rex bypass in a single centre.
  
  
  METHODS
  Data were collected from children with a PSS and/or Rex bypass between 1992 and 2006 at Mount Sinai Medical Center, New York.
  
  
  RESULTS
  Median age at surgery was 10.7 years (range 0.3-22.0 years). Indications included: (i) refractory gastrointestinal bleeding in portal hypertension associated with (a) compensated cirrhosis (n= 12), (b) portal vein thrombosis (n= 10), (c) hepatoportal sclerosis (n= 3); (ii) refractory ascites secondary to Budd-Chiari syndrome (n= 3), and (iii) familial hypercholesterolaemia (n= 4). There were 20 distal splenorenal, four portacaval, three Rex bypass, two mesocaval, two mesoatrial and one proximal splenorenal shunts. At the last follow-up (median 2.9 years, range 0.1-14.1 years), one shunt (Rex bypass) was thrombosed. Two patients had died and two had required a liver transplant. These had a patent shunt at last imaging prior to death or transplant.
  
  
  CONCLUSIONS
  Portosystemic shunts and Rex bypass have been used to manage portal hypertension with excellent outcomes. In selected children with compensated liver disease, PSS may act as a bridge to liver transplantation or represent an attractive alternative.
authors: Recanati Miller Transplant Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors: Sukru
authors: S
authors: Emre
authors: Christina
authors: C
authors: Dugan
authors: Tamara
authors: T
authors: Frankenberg
authors: Lisa Cooper
authors: LC
authors: Hudgins
authors: Rosemarie
authors: R
authors: Gagliardi
authors: A Tarik
authors: AT
authors: Artis
authors: Gonzalo
authors: G
authors: Rodriguez-Laiz
authors: Gabriel
authors: G
authors: Gondolesi
authors: Benjamin L
authors: BL
authors: Shneider
authors: Nanda
authors: N
authors: Kerkar