https://pubmed.ncbi.nlm.nih.gov/33388243/ EHPVO

Review
HPB (Oxford). 2020 Dec 30;S1365-182X(20)32394-7. doi: 10.1016/j.hpb.2020.11.1149. Online ahead of print.

Surgical shunts for extrahepatic portal vein obstruction in pediatric patients: a systematic review

Shannon Zielsdorf 1 , Lalita Narayanan 2 , Sophia Kantymyr 2 , Arianna Barbetta 3 , Yong Kwon 4 , Kambiz Etesami 4 , Yuri Genyk 4 , Juliet Emamaullee 4

Abstract

Background: Extrahepatic portal vein obstruction (EHPVO) causes portal hypertension in noncirrhotic children. Among surgical treatments, it is unclear whether the meso-Rex shunt (MRS) or portosystemic shunt (PSS) offers lower post-operative morbidity and superior patency over time. Our objective was to evaluate long-term outcomes comparing MRS and PSS for pediatric patients with EHPVO.

Methods:A systematic review was conducted of articles reporting children undergoing surgical shunts for EHPVO from 1/2000-2/2020. Of 87 articles screened, 22 were eligible for inclusion. The primary outcome was shunt thrombosis and secondary outcomes included non-operative complications, stenosis, and re-operation.

Results: Eighteen of 22 studies were of good quality and four had fair quality. Of 461 patients included, 340 underwent MRS and 121 underwent PSS. MRS were associated with a higher rate of post-operative thrombosis when compared to PSS (14.1% vs 5.8%, p = 0.021). There were 40/340 MRS patients (11.8%) that required at least one re-operation for either shunt thrombosis or stenosis, versus 5/121 PSS patients (4.1%), p = 0.019.

Conclusion: Both MRS and PSS result in acceptable long-term patency rates, but the more technically demanding MRS is associated with higher post-shunt thrombosis, often requiring further operative intervention. This study suggests that PSS may offer advantages for pediatric patients with EHPVO.