title: Spleen-preserving proximal splenic-left intrahepatic portal shunt for the treatment of extrahepatic portal hypertension in children.
abstract: OBJECTIVE
  The Rex shunt has been employed successfully to treat patients with extrahepatic portal hypertension. In the conventional Rex shunt, the internal jugular vein is used as a venous graft. Inevitably, such a procedure requires neck exploration and sacrifice of the internal jugular vein. The authors describe a novel adaptation of spleen-preserving spleno-Rex bypass, successfully carried out in children with extrahepatic portal hypertension.
  
  
  METHODS
  The mean age of the four patients (1 boy, 3 girls) was 46 months at the time of operation. All children had a history of upper gastrointestinal bleeding, and suffered from splenomegaly and hypersplenism. Spleen-preserving proximal splenic-left intrahepatic portal shunt was performed in all patients. The splenic artery and vein were ligated at the splenic hilum, and the splenic vein was completely separated from the bed of the pancreas to its junction with the inferior mesenteric vein. The freed splenic vein was anastomosed to left portal vein. The short gastric and left gastroepiploic vessels were kept intact to supply and drain the spleen. All patients were followed-up for 7-33 months (median: 21.5 months).
  
  
  RESULTS
  The spleen-preserving spleno-Rex bypass was successfully performed in all 4 patients. The median operative time was 225 min (range: 215-260 min). One patient received blood transfusion, and the postoperative length of hospital stay varied from 4 to 6 days (median: 4.5 days). Intraoperative portal venous angiography demonstrated the patency of the shunt in all patients. Postoperatively, the complete blood count normalized and the biochemistry tests were within normal range. Postoperative ultrasound confirmed shunt patency and satisfactory flow in the proximal splenic-portal shunt in each patient. The size of the spleen decreased and there was no recurrence of variceal bleeding.
  
  
  CONCLUSIONS
  The spleen-preserving spleno-Rex bypass is a viable option to treat EHPVO in children.
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China.
authors.forename: Jin-Shan
authors.initials: JS
authors.lastname: Zhang
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China. Electronic address: lilong22@hotmail.com.
authors.forename: Long
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China.
authors.forename: Wen-Ying
authors.initials: WY
authors.lastname: Hou
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China.
authors.forename: Shu-Li
authors.initials: SL
authors.lastname: Liu
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Diao
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China.
authors.forename: Mao
authors.initials: M
authors.lastname: Ye
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China.
authors.forename: An-Xiao
authors.initials: AX
authors.lastname: Ming
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Dong
authors.affiliation: Departments of Paediatrics and Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia; Department of Surgery, Beijing United Family Hospital, China. Electronic address: wei.cheng@monash.edu.
authors.forename: Wei
authors.initials: W
authors.lastname: Cheng
mesh_terms: D000792:Angiography; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011169:Portal Vein / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D012189:Retrospective Studies; D013154:Spleen / Q000098:blood supply / Q000601:surgery*; D013157:Splenic Artery / Q000601:surgery*; D013162:Splenic Vein / Q000601:surgery*
keywords: Children; Extra-hepatic portal hypertension; Rex shunt; Spleno-Rex bypass