Arianna Bertocchini1, Pierluigi Falappa2, Chiara Grimaldi1, Giuseppe Bolla2, Lidia Monti3, Jean de Ville de Goyet4. 1. HepatoBilioPancreatic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy. 2. Interventional Radiology Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy. 3. HepatoBilio and Digestive Radiology Unit, Department of Imaging, Bambino Gesù Children's Hospital, Rome, Italy. 4. HepatoBilioPancreatic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy. Electronic address: deville@opbg.net.
Abstract
BACKGROUND: Children with extrahepatic portal hypertension typically present with cavernomatous transformation of the portal vein and a poorly defined intrahepatic portal vein system on conventional imaging. With the Meso-Rex Bypass becoming the gold-standard intervention for a cure, a precise assessment of the intrahepatic portal vein system provides helpful data for deciding whether a Meso-Rex Bypass is feasible or not. METHODS: All children with extrahepatic portal hypertension were prospectively assessed by wedged hepatic venous portography. Venous anatomy was categorized into five subtypes (A to E), depending on the presence of thrombosis in the Rex recessus, or not, and its extension within the intrahepatic portal venous system. RESULTS: Eighty-nine children entered the study. Previous umbilical vein catheterization is usually associated with Rex thrombosis, while the Rex recessus and the intrahepatic portal venous system are patent in idiopathic cases, thus allowing for the performance of a Meso-Rex Bypass with a good outcome. CONCLUSIONS: Wedged hepatic venous portography is a very effective tool for detailed preoperative assessment and identification of children being considered for Meso-Rex Bypass surgery. An anatomic-radiological classification is useful in selecting patients for Meso-Rex Bypass with anticipation of a high rate of success.
BACKGROUND:Children with extrahepatic portal hypertension typically present with cavernomatous transformation of the portal vein and a poorly defined intrahepatic portal vein system on conventional imaging. With the Meso-Rex Bypass becoming the gold-standard intervention for a cure, a precise assessment of the intrahepatic portal vein system provides helpful data for deciding whether a Meso-Rex Bypass is feasible or not. METHODS: All children with extrahepatic portal hypertension were prospectively assessed by wedged hepatic venous portography. Venous anatomy was categorized into five subtypes (A to E), depending on the presence of thrombosis in the Rex recessus, or not, and its extension within the intrahepatic portal venous system. RESULTS: Eighty-nine children entered the study. Previous umbilical vein catheterization is usually associated with Rex thrombosis, while the Rex recessus and the intrahepatic portal venous system are patent in idiopathic cases, thus allowing for the performance of a Meso-Rex Bypass with a good outcome. CONCLUSIONS: Wedged hepatic venous portography is a very effective tool for detailed preoperative assessment and identification of children being considered for Meso-Rex Bypass surgery. An anatomic-radiological classification is useful in selecting patients for Meso-Rex Bypass with anticipation of a high rate of success.
Authors: Fabrizio di Francesco; Lidia Monti; Chiara Grimaldi; Cristina Lo Zupone; Arianna Bertocchini; Jean de Ville de Goyet Journal: Pediatr Surg Int Date: 2014-11-18 Impact factor: 1.827
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