Related Experiment Video

Updated: Feb 13, 2026

Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
14:59

Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus

Published on: October 14, 2022

10.7K

Surgical treatment for rebleeding caused by bypass failure after Rex shunt: re-Rex shunt or Warren shunt?

Jin-Shan Zhang1, Long Li2,3, Wei Cheng4,5

  • 1Department of General Surgery, Capital institute of Pediatrics, Beijing, People's Republic of China.

Pediatric Surgery International
|March 17, 2018
PubMed

Insights

Warren shunt is a superior surgical option for treating rebleeding after Rex shunt in children with extrahepatic portal venous obstruction (EHPVO). This approach offers better bypass vein patency and reduced rebleeding rates compared to re-Rex shunt.

Area of Science:

  • Pediatric Surgery
  • Vascular Surgery
  • Gastroenterology

Background:

  • Extrahepatic portal venous obstruction (EHPVO) is a serious condition in children, often treated with Rex shunt.
  • Rebleeding occurs in 4-20% of children post-Rex shunt due to graft complications.
  • Surgical management of rebleeding after Rex shunt requires careful consideration of alternative procedures.

Purpose of the Study:

  • To evaluate the effectiveness of surgical treatments for rebleeding following Rex shunt in pediatric patients.
  • To compare re-Rex shunt with Warren shunt for managing bypass failure after initial Rex shunt.

Main Methods:

  • A retrospective review of 12 children with EHPVO who underwent a second operation between June 2008 and January 2017.
  • Diagnosis of bypass vein issues (occlusion/stenosis) confirmed by ultrasound and CT.
  • Surgical interventions included re-Rex shunt (n=8) and Warren shunt (n=5), with one re-Rex converted to Warren shunt.

Main Results:

  • Warren shunt demonstrated significantly lower postoperative rebleeding and esophageal varices incidence compared to re-Rex shunt (P=0.027 and 0.015).
  • Bypass vein patency rates were higher with Warren shunt (100%) versus re-Rex shunt (50%) after the second operation.
  • Children undergoing Warren shunt experienced significantly greater spleen size reduction postoperatively (P<0.05).

Conclusions:

  • Warren shunt is a more effective treatment for pediatric rebleeding secondary to bypass failure after Rex shunt.
  • The improved outcomes with Warren shunt include better graft patency and reduced clinical complications.
  • This study highlights the advantages of Warren shunt in complex EHPVO management requiring revision surgery.
Abstract

Keywords:
ChildrenExtrahepatic portal venous obstructionRecurrenceRex shuntTreatmentWarren shunt

More Related Videos

Grade III Varicocele Surgical Treatment using Spermatic Vein-Superficial Abdominal Vein Shunt05:00

Grade III Varicocele Surgical Treatment using Spermatic Vein-Superficial Abdominal Vein Shunt

Published on: August 23, 2024

2.8K
Shunt Surgery, Right Heart Catheterization, and Vascular Morphometry in a Rat Model for Flow-induced Pulmonary Arterial Hypertension09:23

Shunt Surgery, Right Heart Catheterization, and Vascular Morphometry in a Rat Model for Flow-induced Pulmonary Arterial Hypertension

Published on: February 11, 2017

17.5K

Related Concept Videos

Shunt Admittances01:26

Shunt Admittances

Shunt admittances play a crucial role in the analysis of transmission lines, particularly for three-phase systems with neutral conductors. When a uniformly charged conductor is positioned above the Earth, it induces an equal but opposite charge on its surface. This interaction creates electric field lines between the conductor and the Earth.
To model this effect, the method of images is employed. This method involves replacing the Earth with an image conductor that mirrors the original...
506
Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure01:16

Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure

Oxygen therapy has emerged as a significant tool in enhancing the quality of life for patients suffering from pulmonary arterial hypertension (PAH). While this therapy has principally been studied on patients with significant hypoxemia, this therapeutic approach helps prevent potential organ damage and can be administered in the comfort of one's home.
Oxygen therapy is vital in increasing and maintaining blood oxygen levels in PAH patients. As a result, it aids in reducing fatigue,...
634
Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
4.0K
Heart Failure I: Introduction01:27

Heart Failure I: Introduction

Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
951
Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
1.0K
Acute Respiratory Failure-I01:21

Acute Respiratory Failure-I

Acute respiratory failure is a condition characterized by the inability of the lungs to perform their primary function: gas exchange. This failure leads to insufficient oxygen levels (hypoxemia) in the blood, elevated carbon dioxide levels (hypercapnia), or both, causing critical impairment in organ function.
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
1.1K