Study Find Advantages With Meso-Rex Bypass

PALM DESERT, CALIF. – Compared with portosystemic shunting in the management of extrahepatic portal vein obstruction, mesenterico-left portal vein bypass restores portal circulation and achieves superior relief of thrombocytopenia and certain metabolic symptoms, results from a single-center study showed.

"For surgeons who still perform portosystemic shunts as a first-line operation for extrahepatic portal vein obstruction, we hope that this evidence provides further proof of the advantages of doing the mesenterico-left portal vein bypass," Dr. Timothy B. Lautz said at the annual meeting of the American Pediatric Surgical Association.

Modern surgical options for extrahepatic portal vein obstruction include the distal splenorenal shunt and the mesenterico-left portal vein bypass (meso-Rex). "The distal splenorenal shunt preserves the spleen but diverts the splenic portion of portal flow into the systemic circulation," said Dr. Lautz of the department of surgery at Children’s Memorial Hospital, the primary pediatric teaching hospital of Northwestern University, Chicago.

"The meso-Rex bypass, on the other hand, is a totally restorative procedure that diverts all portal flow around the area of obstruction and into the intrahepatic left portal vein," he said.

In an effort to compare the two procedures, Dr. Lautz and senior author Dr. Riccardo A. Superina evaluated 91 consecutive patients who underwent an operation for extrahepatic portal vein obstruction at the hospital between 1998 and 2009. Their mean age was 7 years, and 58% were male. Meso-Rex bypass was the treatment of choice in all cases, but portosytemic shunts were reserved for those with anatomic or technical constraints that prevented meso-Rex. Analysis was limited to patients with at least 1 year of postoperative follow-up.

Dr. Lautz reported that 72 patients underwent the meso-Rex procedure (group 1) and 19 underwent portosystemic shunts (group 2). Prior to surgery, patients in both groups experienced growth retardation, thrombocytopenia, hyperammonemia, and impaired synthetic function.

Following surgery, variceal bleeding resolved in 59 of the group-1 patients and in 13 group-2 patients who manifested this symptom preoperatively. In addition, group-1 patients had significantly better improvements compared with group-2 patients in weight for age z-score (+0.76 vs. +0.13, respectively; P = .048), platelet count (+77,700 vs. +29,000 per mL; P = 0.006), international normalized ratio (-0.23 vs. +0.22; P = .002), and serum ammonia (-25.5 vs. +18 micromol/L; P = .002).

"The meso-Rex bypass and portosystemic shunts are both effective at relieving portal hypertensive bleeding," Dr. Lautz concluded. "By restoring normal physiologic portal venous circulation, the meso-Rex bypass better relieves hypersplenism, liver dysfunction, and growth impairment."

Dr. Lautz said he had no relevant financial disclosures to make.

The meeting was supported by a grant from Elsevier, which owns this news organization.

PALM DESERT, CALIF. – Compared with portosystemic shunting in the management of extrahepatic portal vein obstruction, mesenterico-left portal vein bypass restores portal circulation and achieves superior relief of thrombocytopenia and certain metabolic symptoms, results from a single-center study showed.

"For surgeons who still perform portosystemic shunts as a first-line operation for extrahepatic portal vein obstruction, we hope that this evidence provides further proof of the advantages of doing the mesenterico-left portal vein bypass," Dr. Timothy B. Lautz said at the annual meeting of the American Pediatric Surgical Association.

Modern surgical options for extrahepatic portal vein obstruction include the distal splenorenal shunt and the mesenterico-left portal vein bypass (meso-Rex). "The distal splenorenal shunt preserves the spleen but diverts the splenic portion of portal flow into the systemic circulation," said Dr. Lautz of the department of surgery at Children’s Memorial Hospital, the primary pediatric teaching hospital of Northwestern University, Chicago.

"The meso-Rex bypass, on the other hand, is a totally restorative procedure that diverts all portal flow around the area of obstruction and into the intrahepatic left portal vein," he said.

In an effort to compare the two procedures, Dr. Lautz and senior author Dr. Riccardo A. Superina evaluated 91 consecutive patients who underwent an operation for extrahepatic portal vein obstruction at the hospital between 1998 and 2009. Their mean age was 7 years, and 58% were male. Meso-Rex bypass was the treatment of choice in all cases, but portosytemic shunts were reserved for those with anatomic or technical constraints that prevented meso-Rex. Analysis was limited to patients with at least 1 year of postoperative follow-up.

Dr. Lautz reported that 72 patients underwent the meso-Rex procedure (group 1) and 19 underwent portosystemic shunts (group 2). Prior to surgery, patients in both groups experienced growth retardation, thrombocytopenia, hyperammonemia, and impaired synthetic function.

Following surgery, variceal bleeding resolved in 59 of the group-1 patients and in 13 group-2 patients who manifested this symptom preoperatively. In addition, group-1 patients had significantly better improvements compared with group-2 patients in weight for age z-score (+0.76 vs. +0.13, respectively; P = .048), platelet count (+77,700 vs. +29,000 per mL; P = 0.006), international normalized ratio (-0.23 vs. +0.22; P = .002), and serum ammonia (-25.5 vs. +18 micromol/L; P = .002).

"The meso-Rex bypass and portosystemic shunts are both effective at relieving portal hypertensive bleeding," Dr. Lautz concluded. "By restoring normal physiologic portal venous circulation, the meso-Rex bypass better relieves hypersplenism, liver dysfunction, and growth impairment."

Dr. Lautz said he had no relevant financial disclosures to make.

The meeting was supported by a grant from Elsevier, which owns this news organization.

PALM DESERT, CALIF. – Compared with portosystemic shunting in the management of extrahepatic portal vein obstruction, mesenterico-left portal vein bypass restores portal circulation and achieves superior relief of thrombocytopenia and certain metabolic symptoms, results from a single-center study showed.

"For surgeons who still perform portosystemic shunts as a first-line operation for extrahepatic portal vein obstruction, we hope that this evidence provides further proof of the advantages of doing the mesenterico-left portal vein bypass," Dr. Timothy B. Lautz said at the annual meeting of the American Pediatric Surgical Association.

Modern surgical options for extrahepatic portal vein obstruction include the distal splenorenal shunt and the mesenterico-left portal vein bypass (meso-Rex). "The distal splenorenal shunt preserves the spleen but diverts the splenic portion of portal flow into the systemic circulation," said Dr. Lautz of the department of surgery at Children’s Memorial Hospital, the primary pediatric teaching hospital of Northwestern University, Chicago.

"The meso-Rex bypass, on the other hand, is a totally restorative procedure that diverts all portal flow around the area of obstruction and into the intrahepatic left portal vein," he said.

In an effort to compare the two procedures, Dr. Lautz and senior author Dr. Riccardo A. Superina evaluated 91 consecutive patients who underwent an operation for extrahepatic portal vein obstruction at the hospital between 1998 and 2009. Their mean age was 7 years, and 58% were male. Meso-Rex bypass was the treatment of choice in all cases, but portosytemic shunts were reserved for those with anatomic or technical constraints that prevented meso-Rex. Analysis was limited to patients with at least 1 year of postoperative follow-up.

Dr. Lautz reported that 72 patients underwent the meso-Rex procedure (group 1) and 19 underwent portosystemic shunts (group 2). Prior to surgery, patients in both groups experienced growth retardation, thrombocytopenia, hyperammonemia, and impaired synthetic function.

Following surgery, variceal bleeding resolved in 59 of the group-1 patients and in 13 group-2 patients who manifested this symptom preoperatively. In addition, group-1 patients had significantly better improvements compared with group-2 patients in weight for age z-score (+0.76 vs. +0.13, respectively; P = .048), platelet count (+77,700 vs. +29,000 per mL; P = 0.006), international normalized ratio (-0.23 vs. +0.22; P = .002), and serum ammonia (-25.5 vs. +18 micromol/L; P = .002).

"The meso-Rex bypass and portosystemic shunts are both effective at relieving portal hypertensive bleeding," Dr. Lautz concluded. "By restoring normal physiologic portal venous circulation, the meso-Rex bypass better relieves hypersplenism, liver dysfunction, and growth impairment."

Dr. Lautz said he had no relevant financial disclosures to make.

The meeting was supported by a grant from Elsevier, which owns this news organization.