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Surgical treatment for rebleeding caused by bypass failure after Rex shunt: re-Rex shunt or Warren shunt?

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Abstract

Purpose

Although Rex shunt is an effective treatment for extrahepatic portal venous obstruction (EHPVO), 4–20% children develop rebleeding postoperatively. This study was used to evaluate the surgical treatment of rebleeding after Rex shunt in our center.

Method

From June 2008 to Jan 2017, 12 of 122 children with EHPVO underwent a second operation due to graft stenosis and occlusion after Rex shunt in our center. The abdominal ultrasound and computed tomography (CT) showed the occlusion of bypass vein in nine children, stenosis of bypass vein in two children, and the patency of bypass vein in one child with dysplasia of intrahepatic portal vein. A re-Rex shunt was performed in eight children, of which one child required conversion to Warren shunt due to postoperative rebleeding. Five children underwent Warren shunt due to a narrowed left portal vein shown by intraoperative portal angiography and surgical exploration. All patients were followed up in this study.

Results

The postoperative incidences of re-bleeding and esophageal varices in children with Warren shunt were significantly lower than those in children undergoing re-Rex shunt (P = 0.027 and 0.015). After a second operation, the rate of bypass vein patency in children with re-Rex shunt was lower than that in children with Warren shunt (50 vs. 100%). The postoperative reduced size of spleen in children undergoing Warren shunt was significantly higher than that of children undergoing re-Rex shunt (P < 0.05).

Conclusions

Comparing to re-Rex shunt, Warren shunt was a better treatment for rebleeding caused by bypass failure after Rex shunt.

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Funding

This study has received funding from Natural Nature Science Foundation of China (Code: 81770595), Beijing Municipal Administration of Hospitals’ Youth Program (Code: QML20161304) and Capital special health development research (Code: 2016-4-2104).

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Authors and Affiliations

  1. Department of General Surgery, Capital institute of Pediatrics, Beijing, People’s Republic of China

    Jin-Shan Zhang & Long Li

  2. Department of Pediatric Surgery, Beijing United Family Hospital, Beijing, People’s Republic of China

    Wei Cheng

  3. Departments of Pediatric, Monash Children’s, Monash University, Clayton, VIC, Australia

    Wei Cheng

  4. Department of Pediatric Surgery, Capital institute of Pediatrics, No. 2 Yabaolu Rd., Beijing, 100020, People’s Republic of China

    Long Li

Authors
  1. Jin-Shan Zhang
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  2. Long Li
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  3. Wei Cheng
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Corresponding author

Correspondence to Long Li.

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Conflict of interest

The authors declare no conflicts of interest.

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Zhang, JS., Li, L. & Cheng, W. Surgical treatment for rebleeding caused by bypass failure after Rex shunt: re-Rex shunt or Warren shunt?. Pediatr Surg Int 34, 521–527 (2018). https://doi.org/10.1007/s00383-018-4246-0

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  • DOI: https://doi.org/10.1007/s00383-018-4246-0

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