Journal of pediatric surgery · 2026
Is a history of umbilical vein catheterization a contraindication to Meso-Rex bypass for extrahepatic portal vein obstruction in children?
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Kassir Rani, Gortan Marianna, Lozach Cécile, Loiselet Klervie, Drabent Philippe, Corte Federica di, Querciagrossa Stefania, Bustarret Olivier, Jugie Myriam, Cucinotta Ugo, Mayer Claire, Sissaoui Samira, Girard Muriel, Debray Dominique, Lacaille Florence, Capito Carmen, Chardot Christophe
Аннотация
BACKGROUND: Extrahepatic portal vein obstruction (EHPVO) can result in various complications, including life threatening gastrointestinal bleeding. The Meso-Rex bypass (MRB) restores a physiological portal flow. However a history of umbilical vein catheterization (UVC) has sometimes been considered as a contraindication to MRB.
OBJECTIVE: To evaluate the feasibility and results of MRB in children with EHPVO secondary to UVC.
METHODS: We performed a retrospective, single-center study of 51 children with EHPVO in native (non-transplanted) livers treated between 2009 and 2023. All patients underwent preoperative retrograde portography (RP) to assess intrahepatic portal venous system (IPVS) patency with measurement of transhepatic pressure gradient and a liver biopsy.
RESULTS: Of the 51 patients, 23 (45%) had a history of UVC. IPVS was patent in 9/23 (39%) versus 21/28 patients without UVC (75%) (p = 0.0096). None had significant liver fibrosis. Thirty patients underwent MRB. After a median follow-up of 5.7 years, long-term shunt patency was achieved in 29 of 30 patients (96.6%). Two episodes of thrombosis were observed: one early (day 4, managed with surgical thrombectomy) and one late (18 months, managed conservatively). Eleven patients (36%) developed secondary shunt stenosis, successfully treated with radiologic balloon angioplasty in all but one case. The incidence of vascular complications was similar in UVC and non-UVC groups (33% vs. 38%, NS).
CONCLUSION: A history of UVC significantly reduces the patency of IPVS but is not a contraindication to MRB when the IPVS is patent on retrograde portography and the liver is not fibrotic.
OBJECTIVE: To evaluate the feasibility and results of MRB in children with EHPVO secondary to UVC.
METHODS: We performed a retrospective, single-center study of 51 children with EHPVO in native (non-transplanted) livers treated between 2009 and 2023. All patients underwent preoperative retrograde portography (RP) to assess intrahepatic portal venous system (IPVS) patency with measurement of transhepatic pressure gradient and a liver biopsy.
RESULTS: Of the 51 patients, 23 (45%) had a history of UVC. IPVS was patent in 9/23 (39%) versus 21/28 patients without UVC (75%) (p = 0.0096). None had significant liver fibrosis. Thirty patients underwent MRB. After a median follow-up of 5.7 years, long-term shunt patency was achieved in 29 of 30 patients (96.6%). Two episodes of thrombosis were observed: one early (day 4, managed with surgical thrombectomy) and one late (18 months, managed conservatively). Eleven patients (36%) developed secondary shunt stenosis, successfully treated with radiologic balloon angioplasty in all but one case. The incidence of vascular complications was similar in UVC and non-UVC groups (33% vs. 38%, NS).
CONCLUSION: A history of UVC significantly reduces the patency of IPVS but is not a contraindication to MRB when the IPVS is patent on retrograde portography and the liver is not fibrotic.