Is re-Rex shunt a better choice for patients with failed Rex shunt?
PurposeTo review our single-center surgical outcomes of redo operations after failed Rex shunt procedures.MethodsFrom September 2017 to October 2021, a total of 20 patients (11 males, 9 females; median age: 8.6 years) with Rex shunt occlusions were admitted to our hospital. Two of these patients wer...
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| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-06-01
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| Series: | Frontiers in Pediatrics |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2023.1135059/full |
| _version_ | 1827916345201655808 |
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| author | Zhe Wen Jieqin Wang Chao Yang Tao Liu Qifeng Liang Jiankun Liang Yu Ning Fuyu You Xiaoling Bai Miao Hong |
| author_facet | Zhe Wen Jieqin Wang Chao Yang Tao Liu Qifeng Liang Jiankun Liang Yu Ning Fuyu You Xiaoling Bai Miao Hong |
| author_sort | Zhe Wen |
| collection | DOAJ |
| description | PurposeTo review our single-center surgical outcomes of redo operations after failed Rex shunt procedures.MethodsFrom September 2017 to October 2021, a total of 20 patients (11 males, 9 females; median age: 8.6 years) with Rex shunt occlusions were admitted to our hospital. Two of these patients were previously operated on in our hospital, and the remaining 18 were from other centers. All patients underwent repeat operations after detailed preoperative evaluations.ResultsPreoperative wedged hepatic vein portography (WHVP) was conducted for 18 patients. Thirteen patients exhibited well-developed Rex recessus and intrahepatic portal vein during WHPV examination, consistent with the intraoperative exploration results. Fifteen patients (75%, 15/20) underwent redo-Rex shunt, four underwent Warren shunt and one underwent devascularization surgery. During the redo-Rex shunt operations, the left internal jugular veins (IJV) were used as bypass grafts in 11 patients; the intra-abdominal veins were used in 4 patients. The patients were followed up for 12–59 months (mean, 24.8 months). After redo Rex shunts, the grafts were patent in 14 patients (93.3%, 14/15), but 1 graft had thrombosis (6.7%, 1/15). Three patients suffered from postoperative anastomotic stenosis, and all of the stenosis was relieved with balloon dilatations. After re-Rex shunts, esophageal varices and spleen size were substantially reduced, and the platelet count significantly increased. Postoperative graft thrombosis was found in 1 patient after Warren shunt (1/4, 25%), and there was no graft stenosis. Compared with Warren surgery, patients who underwent re-Rex shunt had a significantly higher rate of platelet increase.ConclusionsRedo-rex shunts can be finished in most patients with failed Rex shunts. Re-Rex shunt is a preferred surgical choice after a failed Rex shunt when a good bypass graft is available, and the surgical success rate can reach more than 90%. A suitable bypass graft is essential for a successful redo Rex shunt. Preoperative WHVP is recommended for the design of a redo surgical plan preoperatively. |
| first_indexed | 2024-03-13T03:12:48Z |
| format | Article |
| id | doaj.art-41d668f345eb48b3886bf6c6d557cb20 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-03-13T03:12:48Z |
| publishDate | 2023-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-41d668f345eb48b3886bf6c6d557cb202023-06-26T08:53:55ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602023-06-011110.3389/fped.2023.11350591135059Is re-Rex shunt a better choice for patients with failed Rex shunt?Zhe Wen0Jieqin Wang1Chao Yang2Tao Liu3Qifeng Liang4Jiankun Liang5Yu Ning6Fuyu You7Xiaoling Bai8Miao Hong9Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Medical University, Guangzhou, ChinaDepartment of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Medical University, Guangzhou, ChinaDepartment of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Medical University, Guangzhou, ChinaDepartment of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Medical University, Guangzhou, ChinaDepartment of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Medical University, Guangzhou, ChinaDepartment of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Medical University, Guangzhou, ChinaDepartment of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Medical University, Guangzhou, ChinaDepartment of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Medical University, Guangzhou, ChinaDepartment of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Medical University, Guangzhou, ChinaClinical Data Center, Guangzhou Women and Children's Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Institute of Pediatrics, Guangzhou Medical University, Guangzhou, ChinaPurposeTo review our single-center surgical outcomes of redo operations after failed Rex shunt procedures.MethodsFrom September 2017 to October 2021, a total of 20 patients (11 males, 9 females; median age: 8.6 years) with Rex shunt occlusions were admitted to our hospital. Two of these patients were previously operated on in our hospital, and the remaining 18 were from other centers. All patients underwent repeat operations after detailed preoperative evaluations.ResultsPreoperative wedged hepatic vein portography (WHVP) was conducted for 18 patients. Thirteen patients exhibited well-developed Rex recessus and intrahepatic portal vein during WHPV examination, consistent with the intraoperative exploration results. Fifteen patients (75%, 15/20) underwent redo-Rex shunt, four underwent Warren shunt and one underwent devascularization surgery. During the redo-Rex shunt operations, the left internal jugular veins (IJV) were used as bypass grafts in 11 patients; the intra-abdominal veins were used in 4 patients. The patients were followed up for 12–59 months (mean, 24.8 months). After redo Rex shunts, the grafts were patent in 14 patients (93.3%, 14/15), but 1 graft had thrombosis (6.7%, 1/15). Three patients suffered from postoperative anastomotic stenosis, and all of the stenosis was relieved with balloon dilatations. After re-Rex shunts, esophageal varices and spleen size were substantially reduced, and the platelet count significantly increased. Postoperative graft thrombosis was found in 1 patient after Warren shunt (1/4, 25%), and there was no graft stenosis. Compared with Warren surgery, patients who underwent re-Rex shunt had a significantly higher rate of platelet increase.ConclusionsRedo-rex shunts can be finished in most patients with failed Rex shunts. Re-Rex shunt is a preferred surgical choice after a failed Rex shunt when a good bypass graft is available, and the surgical success rate can reach more than 90%. A suitable bypass graft is essential for a successful redo Rex shunt. Preoperative WHVP is recommended for the design of a redo surgical plan preoperatively.https://www.frontiersin.org/articles/10.3389/fped.2023.1135059/fullextrahepatic portal venous obstructionportal hypertensionrex shuntwarren shuntreoperation |
| spellingShingle | Zhe Wen Jieqin Wang Chao Yang Tao Liu Qifeng Liang Jiankun Liang Yu Ning Fuyu You Xiaoling Bai Miao Hong Is re-Rex shunt a better choice for patients with failed Rex shunt? Frontiers in Pediatrics extrahepatic portal venous obstruction portal hypertension rex shunt warren shunt reoperation |
| title | Is re-Rex shunt a better choice for patients with failed Rex shunt? |
| title_full | Is re-Rex shunt a better choice for patients with failed Rex shunt? |
| title_fullStr | Is re-Rex shunt a better choice for patients with failed Rex shunt? |
| title_full_unstemmed | Is re-Rex shunt a better choice for patients with failed Rex shunt? |
| title_short | Is re-Rex shunt a better choice for patients with failed Rex shunt? |
| title_sort | is re rex shunt a better choice for patients with failed rex shunt |
| topic | extrahepatic portal venous obstruction portal hypertension rex shunt warren shunt reoperation |
| url | https://www.frontiersin.org/articles/10.3389/fped.2023.1135059/full |
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