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Meso-Rex bypass versus portosystemic shunt for the management of extrahepatic portal vein obstruction in children: systematic review and meta-analysis

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Abstract

Purpose

Extrahepatic portal vein obstruction (EHPVO) is a major cause of non-cirrhotic portal hypertension in children. Surgical procedures for EHPVO include portosystemic shunts (PSS) and meso-Rex bypass (MRB). We conducted a systematic review and meta-analysis to compare the effectiveness of MRB versus PSS in EHPVO patients.

Methods

A systematic literature search was performed using four databases. Articles reporting EHPVO and comparing patients who received MRB and PSS were included in the analysis.

Results

We retrieved 851 papers, of which five observational studies met the inclusion criteria. There was no difference in shunt complications, mortality, or gastrointestinal bleeding after surgery between MRB and PSS in the meta-analysis. MRB had increased shunt complications compared with PSS in the non-comparative studies. MRB had a potential advantage over PSS in long-term prognosis in one comparative study. Overall, the quality of the evidence was low.

Conclusions

Based on available data, our meta-analysis indicates that MRB does not increase shunt complications, mortality, or gastrointestinal bleeding after surgery. The present study did not reveal superiority for either MRB or PSS. The paucity of well conducted trials in this area justifies future multicenter studies and studies that examine long-term outcomes.

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Acknowledgements

AP is supported by a Canadian Institutes of Health Research (CIHR) Foundation Grant 353857. The funding had no impact on study design, data collection, analysis, interpretation, the writing of the report, or the decision to submit the paper for publication.

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Authors and Affiliations

  1. Division of General and Thoracic Surgery, Translational Medicine, The Hospital for Sick Children, 1526-555 University Ave., Toronto, ON, M5G 1X8, Canada

    Masaya Yamoto, Sinobol Chusilp, Mashriq Alganabi, Blayne Amir Sayed & Agostino Pierro

  2. Department of Pediatric Surgery, Shizuoka Children’s Hospital, Shizuoka, Japan

    Masaya Yamoto

  3. Division of Pediatric Surgery, Department of Surgery, Khon Kaen University, Khon Kaen, Thailand

    Sinobol Chusilp

  4. Division of General Surgery, Department of Surgery, Toronto General Hospital-University Health Network, Toronto, ON, Canada

    Blayne Amir Sayed

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  1. Masaya Yamoto
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  2. Sinobol Chusilp
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  3. Mashriq Alganabi
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  4. Blayne Amir Sayed
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  5. Agostino Pierro
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Contributions

MY: conception and design, collection and/or assembly of data, data analysis and interpretation, manuscript writing, final approval of manuscript. SC, YY, MA: collection and/or assembly of data, data analysis and interpretation, final approval of manuscript. BAS: conception and design, final approval of manuscript. AP: conception and design, financial support, final approval of manuscript.

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Correspondence to Agostino Pierro.

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Yamoto, M., Chusilp, S., Alganabi, M. et al. Meso-Rex bypass versus portosystemic shunt for the management of extrahepatic portal vein obstruction in children: systematic review and meta-analysis. Pediatr Surg Int 37, 1699–1710 (2021). https://doi.org/10.1007/s00383-021-04986-z

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