Surgical options including the rex shunt
Your child may be referred for surgery after the initial diagnosis of portal hypertension or later after his symptoms are controlled. There are different surgical options, and the best one will depend on your child's specific needs, the condition of the liver and the condition of the veins inside the abdomen.
Two basic surgical choices include palliative shunts, which essentially decrease the severity of symptoms, and restorative shunts, which restore normal blood flow through the liver.
What is the rex shunt?
Use of the restorative shunt, the meso-rex bypass — or “rex shunt” for short — at Children's Memorial began in 1997, and since then, more than 85 children have been operated on here; they have come from 20 states and five countries. The operation is successful in over 90% of patients. Because the rex shunt restores normal blood flow to an otherwise normal liver, we believe that this is the treatment of choice for children with extra-hepatic portal vein thrombosis (EHPVT).
The shunt bypasses the blocked portal vein and restores venous blood flow to the liver. A vein (usually the jugular vein in the neck) is used to build a bridge around the blockage. Blood flows from the large intestinal veins, across the bridge, around the blockage and back into the liver. Blood can then flow from the intestines into the liver in the “normal” way. If for some reason your child cannot have this procedure, other procedures may be considered. Your surgeon will review the different options with you to determine the best procedure for your child.
The rex shunt was first developed in Europe. We at Children's Memorial Hospital were the first to apply this novel technique in North America, and now have the most extensive experience with this unique surgery. In the last 11 years, the procedure has been refined and modified so that it can be applied to a wider number of children with EHPVT.
Following the surgery, the symptoms of portal hypertension usually resolve very quickly. We also believe that restoration of normal portal blood flow to the liver allows the liver to recover some of the functions that may have been impaired because of the obstruction thereby allowing the child to grow and develop to their full potential.
How long will by child stay in the hospital?
Children spend an average of seven days in hospital after the surgery. Your child will spend 1 to 2 days in the pediatric intensive care unit (PICU) and then the remainder of the stay will be spent on the post-surgical unit. All children receive blood thinners for the first few days after the operation to ensure that the new venous bridge does not clot off. After the children are eating, medicines are given by mouth to slow down clot formation. After the operation, routine tests and abdominal ultrasounds are done to monitor the flow of blood in the new shunt and to make sure that no clots form to obstruct the flow of blood. Children are usually sent home about 7 days after surgery.
Find additional information here regarding your child's in-patient stay at Children's Memorial.
What follow-up care will my child need?
Routine blood tests and ultrasounds are repeated every three months and a CT venogram may be done again one year after surgery. Most children can be monitored at their home centers and return to Chicago for their one-year follow-up whenever possible. Some families prefer to come to Children's Memorial Hospital for their check-ups, and we will do everything possible to make their stay as brief and pleasant as possible.