title: Mesoportal bypass using a constructed saphenous vein graft for extrahepatic portal vein obstruction--technique, feasibility, and outcomes.
abstract: BACKGROUND
  The internal jugular vein is routinely used as a graft for the Rex shunt. We analyzed results of mesoportal bypass using an alternative autologous graft.
  
  
  METHODS
  Twenty-one children with extrahepatic portal vein obstruction were treated with a Rex shunt constructed using both greater saphenous veins. Follow-up included ultrasound and blood count screening at 3, 6, and 12 months and annually thereafter.
  
  
  RESULTS
  Median age was 8.7 years (range, 3.6-14 years), and follow-up time, 5.3 years (range, 0.6-7.1 years). Occlusion or narrowing occurred in 6 patients after a median of 20 months (range, 2.6-52 months). In 2 cases, patency was restored, giving an overall success rate of 81%. During follow-up, no variceal bleeding occurred while hemoglobin, platelet count, and leukocyte levels increased (P ≤ .02 for all) and spleen size decreased (P = .001). Patients with occlusive shunt complications weighed less (P = .01), had higher preoperative platelet levels (P = .02), and tended to have a smaller spleen preoperatively (P = .06) than patients without shunt complications. Cumulative graft patency at 6 months, 1 year, 3 years, and 5 years was 100%, 89%, 82%, and 74%, respectively.
  
  
  CONCLUSIONS
  Rex shunt constructed using the greater saphenous veins is a valuable alternative to the internal jugular vein graft, allowing long-term reversal of portal hypertension, splenomegaly, and hypersplenism. Low patient weight and high platelet count predicted shunt occlusion.
authors.affiliation: Section of Paediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, 00029-HUS, Helsinki, Finland. topi.luoto@uta.fi
authors.forename: Topi
authors.initials: T
authors.lastname: Luoto
authors.forename: Mikko
authors.initials: M
authors.lastname: Pakarinen
authors.forename: Ilkka
authors.initials: I
authors.lastname: Mattila
authors.forename: Risto
authors.initials: R
authors.lastname: Rintala
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery*; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D011183:Postoperative Complications; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D016896:Treatment Outcome