Long-term follow-up, complications and outcomes of Meso-Rex bypass for extrahepatic portal vein obstruction (EHPVO): a systematic review.

Authors

Pietro Riva, Luca Pio, Angelo Zarfati, Emmanuel Gonzales, Antoine Gardin, Stephanie Franchi Abella, Solene Le Cam, Oanez Ackermann, Geraldine Hery, Virginie Fouquet, Nathalie Tarraf, Daniele Alberti, Sophie Branchereau, Florent Guérin

Published in

Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. Jul 27, 2026. Epub Jul 27, 2026.

Abstract

Extrahepatic Portal Vein Obstruction (EHPVO) is the leading cause of prehepatic portal hypertension in children, causing gastrointestinal (GI) bleeding, splenomegaly, and thrombocytopenia. Meso-Rex Bypass (MRB) restores hepatopetal flow, but long-term outcomes remain inconsistently reported. We conducted the first systematic review of long-term outcomes after MRB in pediatric EHPVO.
Following PRISMA guidelines, six databases were systematically searched. Prospective and retrospective studies on pediatric EHPVO patients (0-18 years) undergoing MRB were included. Technical aspects, complications, and functional outcomes were analyzed.
Forty studies (1998-2024), encompassing 1403 MRB operations, were reviewed. Shunt patency was achieved in 87% (1229/1403), with thrombosis in 9% and stenosis in 5%. Recurrent GI bleeding occurred in 13% (92/730). Median follow-up was 30 months (range 1-134). Improvements were observed in platelet counts (24/24 studies), spleen size (decreased in 18/18 studies), leukocytes (8/8), and hemoglobin (4/4). Portal pressures decreased in all eight studies evaluating it, though mean postoperative values remained above 10 mmHg. Growth studies (n = 4) showed maintained or improved anthropometric parameters. Five patients (0.3%) died, with one MRB-related death.
MRB is an effective, durable treatment for pediatric EHPVO with high patency and low mortality. It reverses hypersplenism and improves hematologic parameters while restoring physiologic portal flow. Future research should standardize long-term, multidisciplinary follow-up protocols.

PMID:
42509118
Bibliographic data and abstract were imported from PubMed on 28 Jul 2026.

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