Portal hypertension research articles
The following is a list of Dr. Superina's research articles specific to pediatric portal hypertension and its treatment.
- Superina RA, Bambini DA, Lokar, J, et al. Correction of extrahepatic portal vein thrombosis by the mesenteric to left portal vein bypass. Annals of surgery 2006; 243(4): 515-521.
The goal of this study was to determine the effectiveness of the meso-rex bypass in over 30 patients with extrahepatic portal vein thrombosis (EHPVT). The meso-rex bypass provides excellent relief of symptoms for idiopathic (unknown cause) EPHVT, resulting in liver growth and the return of normal coagulation parameters. It was found that the procedure has predictably better results in infants and young children as compared to adolescents. It was therefore recommended that the operative repair of portal vein obstruction should not be delayed until the child was older.
- Superina RA, Shneider B, Emre S, et al. Surgical guidelines for the management of extra-hepatic portal vein obstruction. Pediatric transplantation 2006; 10(8): 908-913.
This article outlines the recommendations for the treatment of extra hepatic portal vein thrombosis (EHPVT) agreed upon by a panel of experts in pediatric gastroenterology and surgery. The recent introduction of the meso-rex bypass raises a possible paradigm shift in the therapeutic approach to EHPVT. This article only discussed pediatric patients with idiopathic (unknown cause) EHPVT and outlined absolute and relative indications for the meso-rex bypass.
- Mack CL, Zelko FA, Lokar J, et al. Surgically restoring portal blood flow to the liver in children with primary extrahepatic portal vein thrombosis improves fluid neurocognitive ability. Pediatrics 2006;117(3):e405-12.
This study demonstrates that by surgically restoring portal blood flow through a meso-rex bypass in children with EPHVT, fluid cognitive ability is improved.
- Mack CL, Superina, RA, Whitington, PF. Surgical restoration of portal flow corrects procoagulant and anti coagulant deficiencies associated with extra hepatic portal vein thrombosis. Journal of pediatrics 2003 February; 142(2): 197-199.
EHPVT is associated with abnormal coagulation. Eleven children with EHPVT and abnormal coagulating factors underwent a meso-rex bypass to restore portal blood flow. Coagulation factors returned to normal one year after surgery. This research study suggests portal venous flow is essential to maintain normal coagulation.
- Bambini DA, Superina R, Almond PS, Whitington PF, Alonso E. Experience with the rex shunt (mesenterico-left portal bypass) in children with extrahepatic portal hypertension. Journal of pediatric surgery 2000;35(1):13-8; discussion 8-9.
This article details a case study of 5 patients and concluded that the meso-rex shunt is a proven effective method of resolving portal hypertension in children caused by EPHVT. It is the preferred surgical treatment because it eliminates portal hypertension by restoring normal portal blood flow to the liver.
- Chin AC, Thow F, Superina RA. Previous portal hypertension surgery negatively affects results of mesenteric to left portal vein bypass. Journal of pediatric surgery 2008;43(1):114-9; discussion 9.
This article examines the results of the meso-rex bypass obtained in children who had prior surgery for portal hypertension. It was found that children who have had previous surgery for portal hypertension that subsequently fails to achieve the desired results do not have as good a success rate as those children with no previous surgery. These findings suggest that children with portal vein thrombosis should have the meso-rex bypass operation as their first procedure.
- Chiu B, Pillai SB, Sandler AD, Superina RA. Experience with alternate sources of venous inflow in the meso-rex bypass operation: the coronary and splenic veins. Journal of pediatric surgery 2007;42(7):1199-202.
This article describes modifications of the meso-rex bypass procedure in 5 patients. These modified methods used internal abdominal veins such as the splenic or the coronary or the inferior mesenteric veins instead of the internal jugular vein as the conduit for the restoration of normal venous flow to the liver.
- Shneider B, Emre S, Groszmann R, et al. Expert pediatric opinion on the Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. Pediatric transplantation 2006;10(8):893-907.
This article provides a consensus statement by leaders in the field of pediatric portal hypertension and variceal bleeding. It also provided guidelines for the management of patients and for the conduct of clinical trials related to portal hypertension and variceal bleeding.
- Superina RA, Alonso EM. Medical and Surgical Management of Portal Hypertension in Children. Current treatment options in gastroenterology 2006;9(5):432-43.
This chapter details the medical and surgical management of pediatric patients with EPHVT. It provides a thorough explanation of the various components and complexities involved in treatment options of EPHVT.
- Chiu B, Superina RA. Encephalopathy caused by a splenorenal shunt can be reversed by performing a mesenteric-to-left portal vein bypass. Journal of pediatric surgery 2006;41(6):1177-9.
This article highlights a case study in which a patient's encephalopathy was completely reversed by the meso-rex bypass, after the child had initially received a splenorenal shunt.
- Chiu B, Superina R. Extrahepatic portal vein thrombosis is associated with an increased incidence of cholelithiasis. Journal of pediatric surgery 2004;39(7):1059-61.
The authors noted a high incidence of biliary tract problems in patients with EPHVT compared to the average population including stones and sludge in the bile duct and gall bladder. Some patients required surgical removal of the gall bladder. This article highlights the possibility that lack of normal portal vein flow to the liver may affect the make-up of bile and lead to a higher rate of gall stone formation.
- Shilyansky J, Roberts EA, Superina RA. Distal splenorenal shunts for the treatment of severe thrombocytopenia from portal hypertension in children. J Gastrointest Surg 1999;3(2):167-72.
Before the meso-rex bypass operation came into use, the distal splenorenal shunt was used to treat children with symptomatic portal vein obstruction with excellent results. This article provides more information regarding this procedure. The distal splenorenal shunt is now only used to treat children with portal vein obstruction in cases where the meso-rex bypass cannot be done because of anatomical reasons.