Is a history of umbilical vein catheterization a contraindication to Meso-Rex bypass for extrahepatic portal vein obstruction in children?

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.