Role of retropancreatic tunnel established by superior mesenteric vein-approach in a child with cavernous transformation of the portal vein during Rex bypass_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LUO Yang , PENG Yun , WU Yaoxing , XIE Xiaolong , WANG Qi , LÜ Yong ,  LI Kewei , XIANG Bo

1. Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

LI Kewei, Email: vivian5225133@outlook.com

Keywords：

cavernous transformation of the portal vein; retropancreatic tunnel; the superior mesenteric vein; portal vein

DOI：

10.7507/1007-9424.202401105

Video：

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Objective To summarize the clinical experience of retropancreatic tunnel established by superior mesenteric vein-approach in a child with cavernous transformation of the portal vein (CTPV) during Rex bypass. Method The retropancreatic tunnel was created by the superior mesenteric vein-approach during Rex bypass in a child with CTPV who was admitted to our hospital in September, 2023. Clinical data were retrospectively analyzed. Results A 4-year-old male child was diagnosed with CTPV. After the establishment of the retropancreatic tunnel by superior mesenteric vein-approach, the portal vein was quickly identified, thus simplifying the portal dissection. The operation time of Rex bypass was about 8 hours, and intraoperative blood loss was about 60 mL. After a 3-month follow-up, the child recovered well with patent bypass vessels. Conclusion The surgical strategy proposed by our team can simplify the Rex bypass, resulting in more rapid and safe access to the vascular anastomosis site.

1.	Kuy S, Dua A, Rieland J, et al. Cavernous transformation of the portal vein. J Vasc Surg, 2016, 63(2): 529.
2.	Ide T, Ohno Y, Nakanuma Y, et al. Early development of cavernomatous vasculatures in portal venous thrombosis: morphometric kinetics in rabbit model. Hepatol Res, 2003, 27(2): 136-142.
3.	di Francesco F, Del Prete L, Grimaldi C, et al. Pancreatitis and portal vein thrombosis in children: the chicken or the egg causality dilemma. J Pediatr Surg, 2015, 50(4): 565-569.
4.	Salzedas-Netto AA, Duarte AA, Linhares MM, et al. Variation of the Rex shunt for treating concurrent obstruction of the portal and superior mesenteric veins. J Pediatr Surg, 2011, 46(10): 2018-2020.
5.	Wu H, Zhou N, Lu L, et al. Value of preoperative computed tomography for meso-Rex bypass in children with extrahepatic portal vein obstruction. Insights Imaging, 2021, 12(1): 109.
6.	Barakat MT, Foley MA, Gugig R. Initial experience with endoscopic ultrasound-guided coil placement for pediatric gastric variceal hemostasis. J Pediatr Gastroenterol Nutr, 2021, 72(4): 532-537.
7.	Intagliata NM, Caldwell SH, Tripodi A. Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis. Gastroenterology, 2019, 156(6): 1582-1599. e1.
8.	Vianna RM, Mangus RS, Kubal C, et al. Multivisceral transplantation for diffuse portomesenteric thrombosis. Ann Surg, 2012, 255(6): 1144-1150.
9.	de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno Ⅶ - renewing consensus in portal hypertension. J Hepatol, 2022, 76(4): 959-974.
10.	Marot A, Barbosa JV, Duran R, et al. Percutaneous portal vein recanalization using self-expandable nitinol stents in patients with non-cirrhotic non-tumoral portal vein occlusion. Diagn Interv Imaging, 2019, 100(3): 147-156.
11.	魏波, 吴浩, 张静漪, 等. 经皮经肝门静脉成形成功治疗儿童特发性门静脉海绵样变. 中国普外基础与临床杂志, 2023, 30(4): 397-402.
12.	Tang R, Wu G, Yu Q, et al. Location and extent of cavernous transformation of the portal vein dictates different visceral side revascularization in Meso-Rex bypass. BMC Surg, 2023, 23(1): 276.
13.	de Ville de Goyet J, Alberti D, Falchetti D, et al. Treatment of extrahepatic portal hypertension in children by mesenteric-to-left portal vein bypass: a new physiological procedure. Eur J Surg, 1999, 165(8): 777-781.
14.	Lautz TB, Keys LA, Melvin JC, et al. Advantages of the meso-Rex bypass compared with portosystemic shunts in the management of extrahepatic portal vein obstruction in children. J Am Coll Surg, 2013, 216(1): 83-89.
15.	di Francesco F, Grimaldi C, de Ville de Goyet J. Meso-Rex bypass-a procedure to cure prehepatic portal hypertension: the insight and the inside. J Am Coll Surg, 2014, 218(2): e23-e36.
16.	Elnaggar AS, Griesemer AD, Bentley-Hibbert S, et al. Liver atrophy and regeneration in noncirrhotic portal vein thrombosis: effect of surgical shunts. Liver Transpl, 2018, 24(7): 881-887.
17.	Brichard M, Iesari S, Lerut J, et al. Meso-Rex bypass for the management of extrahepatic portal vein obstruction in adults (with video). Hepatobiliary Pancreat Dis Int, 2022, 21(1): 25-32.
18.	Yuldashev RZ, Aliev MM, Maksudov MF, et al. Angiographic patterns of portal venous system in children with extrahepatic portal hypertension and its etiological and clinical relevance. Pediatr Surg Int, 2023, 39(1): 97.
19.	Moon DB, Lee SG, Ahn CS, et al. Restoration of portal flow using a pericholedochal varix in adult living donor liver transplantation for patients with total portosplenomesenteric thrombosis. Liver Transpl, 2014, 20(5): 612-615.
20.	孔俊杰, 沈舒, 黄斌, 等. 自体肝脏移植治疗终末期肝泡型包虫病合并继发性门静脉海绵样变. 中国普外基础与临床杂志, 2018, 25(7): 846-851.
21.	Ramesh Babu CS, Sharma M. Biliary tract anatomy and its relationship with venous drainage. J Clin Exp Hepatol, 2014, 4(Suppl 1): S18-S26.

1. Kuy S, Dua A, Rieland J, et al. Cavernous transformation of the portal vein. J Vasc Surg, 2016, 63(2): 529.
2. Ide T, Ohno Y, Nakanuma Y, et al. Early development of cavernomatous vasculatures in portal venous thrombosis: morphometric kinetics in rabbit model. Hepatol Res, 2003, 27(2): 136-142.
3. di Francesco F, Del Prete L, Grimaldi C, et al. Pancreatitis and portal vein thrombosis in children: the chicken or the egg causality dilemma. J Pediatr Surg, 2015, 50(4): 565-569.
4. Salzedas-Netto AA, Duarte AA, Linhares MM, et al. Variation of the Rex shunt for treating concurrent obstruction of the portal and superior mesenteric veins. J Pediatr Surg, 2011, 46(10): 2018-2020.
5. Wu H, Zhou N, Lu L, et al. Value of preoperative computed tomography for meso-Rex bypass in children with extrahepatic portal vein obstruction. Insights Imaging, 2021, 12(1): 109.
6. Barakat MT, Foley MA, Gugig R. Initial experience with endoscopic ultrasound-guided coil placement for pediatric gastric variceal hemostasis. J Pediatr Gastroenterol Nutr, 2021, 72(4): 532-537.
7. Intagliata NM, Caldwell SH, Tripodi A. Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis. Gastroenterology, 2019, 156(6): 1582-1599. e1.
8. Vianna RM, Mangus RS, Kubal C, et al. Multivisceral transplantation for diffuse portomesenteric thrombosis. Ann Surg, 2012, 255(6): 1144-1150.
9. de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno Ⅶ - renewing consensus in portal hypertension. J Hepatol, 2022, 76(4): 959-974.
10. Marot A, Barbosa JV, Duran R, et al. Percutaneous portal vein recanalization using self-expandable nitinol stents in patients with non-cirrhotic non-tumoral portal vein occlusion. Diagn Interv Imaging, 2019, 100(3): 147-156.
11. 魏波, 吴浩, 张静漪, 等. 经皮经肝门静脉成形成功治疗儿童特发性门静脉海绵样变. 中国普外基础与临床杂志, 2023, 30(4): 397-402.
12. Tang R, Wu G, Yu Q, et al. Location and extent of cavernous transformation of the portal vein dictates different visceral side revascularization in Meso-Rex bypass. BMC Surg, 2023, 23(1): 276.
13. de Ville de Goyet J, Alberti D, Falchetti D, et al. Treatment of extrahepatic portal hypertension in children by mesenteric-to-left portal vein bypass: a new physiological procedure. Eur J Surg, 1999, 165(8): 777-781.
14. Lautz TB, Keys LA, Melvin JC, et al. Advantages of the meso-Rex bypass compared with portosystemic shunts in the management of extrahepatic portal vein obstruction in children. J Am Coll Surg, 2013, 216(1): 83-89.
15. di Francesco F, Grimaldi C, de Ville de Goyet J. Meso-Rex bypass-a procedure to cure prehepatic portal hypertension: the insight and the inside. J Am Coll Surg, 2014, 218(2): e23-e36.
16. Elnaggar AS, Griesemer AD, Bentley-Hibbert S, et al. Liver atrophy and regeneration in noncirrhotic portal vein thrombosis: effect of surgical shunts. Liver Transpl, 2018, 24(7): 881-887.
17. Brichard M, Iesari S, Lerut J, et al. Meso-Rex bypass for the management of extrahepatic portal vein obstruction in adults (with video). Hepatobiliary Pancreat Dis Int, 2022, 21(1): 25-32.
18. Yuldashev RZ, Aliev MM, Maksudov MF, et al. Angiographic patterns of portal venous system in children with extrahepatic portal hypertension and its etiological and clinical relevance. Pediatr Surg Int, 2023, 39(1): 97.
19. Moon DB, Lee SG, Ahn CS, et al. Restoration of portal flow using a pericholedochal varix in adult living donor liver transplantation for patients with total portosplenomesenteric thrombosis. Liver Transpl, 2014, 20(5): 612-615.
20. 孔俊杰, 沈舒, 黄斌, 等. 自体肝脏移植治疗终末期肝泡型包虫病合并继发性门静脉海绵样变. 中国普外基础与临床杂志, 2018, 25(7): 846-851.
21. Ramesh Babu CS, Sharma M. Biliary tract anatomy and its relationship with venous drainage. J Clin Exp Hepatol, 2014, 4(Suppl 1): S18-S26.

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