Meso-Rex Bypass: Insights from a Single-center Experience in India

Abstract

Introduction: The Meso-Rex bypass (MRB) provides a physiological cure for EHPVO by restoring hepatopetal flow, effectively reducing portal pressure. We share our experience with the MRB procedure, its outcomes, and challenges. Aim: To describe the feasibility and effectiveness of MRB in children with EHPVO in our practice. Materials and Methods: This is a retrospective study of children with EHPVO who underwent MRB between January 2013 and May 2024. MRB was considered in patients with asymptomatic splenomegaly, moderate hypersplenism, and patent left portal vein either on Doppler or contrast-enhanced computed tomography. The internal jugular vein was used in all cases as jump graft. At follow-up, Doppler was done to note the patency of the shunt and size of the spleen. Results: Eighty-two shunts of all types were performed. MRB was considered in 17 patients (21%) as per preoperative criteria. MRB was possible in only 10 (12%). Data were analyzed for these 10 children. The average age was 4.5 years (range 1–11 years), 7 were <5 years. Presentation included hematemesis (eight children) and splenomegaly (two children). Four had moderate hypersplenism. Two developed transient self-limiting ascites in early postoperative period. There were no other immediate perioperative complications. The average duration of follow-up was 67 months. One child had hematemesis 2 years after surgery due to stenosis at the proximal end of graft which was treated with endovascular dilatation. Hypersplenism resolved in all children. Conclusion: MRB is the only curative option for EHPVO. It is feasible in a small subset of patients. Outcomes of MRB are good, especially in younger children.

Keywords

• internal jugular vein
• mesoportal bypass
• portal hypertension
• portosystemic shunt
• rex bypass