Modified Meso-Rex bypass with umbilical vein recanalization and intra-operative stenting

BackgroundThe aim of the study was to evaluate the usefulness of a novel modified Meso-Rex bypass surgical technique with umbilical vein recanalization and intraoperative stenting to treat portal vein cavernous transformation. MethodsIn total, 13 portal vein cavernous transformation patients underwent traditional Meso-Rex bypass surgery (Group A, n=8), modified Meso-Rex bypass without stent implantation (Group B, n=1) and modified Meso-Rex bypass with intraoperative stent implantation (Group C, n=4). ResultsIn Group A, the bypass diameter was 2-6 mm (median 3.3 mm) and blood flow velocity 25-115 cm/s (median 75 cm/s) 1 month after Meso-Rex bypass surgery, with open bypass times of 0-59 months (median 16 months); 5 patients in this group developed postoperative Meso-Rex bypass occlusions. One patient in Group B needed a thrombectomy and stent implantation during a second surgery 2 days after the modified Meso-Rex bypass, because of bypass thrombosis and umbilical vein stenosis. In Group C, the average Meso-Rex bypass diameter was 5.5-6.5 mm (median 6 mm) and the bypass vessels remained open in all patients, with blood flow rates of 45-100 cm/s (median 76.5 cm/s) 1 month after Meso-Rex bypass, up to the endpoint (12-26 months, median 18 months). The rate of bypass occlusions in Group A and Group C were 25%, 0%; 25%, 0% and 50%, 0% at 1 month, 3 months and 1 year, respectively, after Meso-Rex bypass surgery.ConclusionsOur novel modified Meso-Rex bypass approach for portal vein cavernous transformation treatment was effective with excellent long-term bypass patency.