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A History of Umbilical Vein Catheterization Does Not Preclude Children from a Successful Meso-Rex Bypass
Caroline P Lemoine1, Stephanie Yang1, Katherine A Brandt1
1Division of Transplant and Advanced Hepatobiliary Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States.
Insights
A history of umbilical vein catheterization (UVC) does not preclude Meso-Rex bypass (MRB) for extrahepatic portal venous obstruction (EHPVO). Patients with UVC history can still benefit from MRB, demonstrating its feasibility in this population.
Area of Science:
- Vascular Surgery
- Pediatric Surgery
- Hepatology
Background:
- Umbilical vein catheterization (UVC) is a risk factor for portal venous thrombosis, potentially leading to extrahepatic portal venous obstruction (EHPVO) and portal hypertension (PHT).
- The feasibility of Meso-Rex bypass (MRB) in patients with a history of UVC has been debated.
- This study investigates the impact of prior UVC on MRB outcomes for EHPVO treatment.
Purpose of the Study:
- To compare the feasibility and success rates of Meso-Rex bypass (MRB) in patients with and without a history of umbilical vein catheterization (UVC).
- To determine if a history of UVC is a contraindication for MRB in treating extrahepatic portal venous obstruction (EHPVO).
Main Methods:
- Retrospective review of 187 patients with EHPVO who underwent evaluation for MRB between 1997 and 2022.
- Patients were divided into two groups: those with a history of UVC (UVC(+)) and those without (UVC(-)).
- Surgical outcomes, including MRB success rates and patency, were compared between the groups.
Main Results:
- A history of UVC was a significant predictor for receiving MRB (OR: 7.4).
- MRB success rates were significantly lower in the UVC(+) group (49.1%) compared to the UVC(-) group (87.7%).
- However, MRB patency at discharge was comparably high in both groups (89.3% in UVC(+) vs. 94.7% in UVC(-)).
Conclusions:
- A history of UVC should not be considered an absolute contraindication for Meso-Rex bypass (MRB).
- Approximately half of patients with prior UVC successfully underwent MRB.
- Patients with symptomatic portal hypertension due to EHPVO warrant consideration for MRB regardless of UVC history.
Introduction:
Umbilical vein catheterization (UVC) can cause portal venous thrombosis, leading to the development of extrahepatic portal venous obstruction (EHPVO) and portal hypertension (PHT). The feasibility of the Meso-Rex bypass (MRB) for the treatment of EHPVO in patients with a history of UVC has been questioned. We compared the feasibility of performing an MRB in patients with or without a history of previous UVC.
Methods:
A retrospective review of patients with EHPVO and known UVC status explored for a possible MRB at our institution was performed (1997-2022). Patients were categorized in two groups: with (UVC(+)) or without (UVC(-)) a history of UVC for comparison. A p-value less than 0.05 was considered significant.
Results:
One hundred and eighty-seven patients were included (n = 57 in UVC(+); n = 130 in UVC(-)). Patients in the UVC group were significantly younger at surgery and the incidence of prematurity was higher. Other risk factors for the development of EHPVO were similar between the groups, but only history of UVC could predict the ability to receive MRB (odds ratio [OR]: 7.4 [3.5-15.4]; p < 0.001). The success rate of MRB was significantly higher in patients with no history of UVC (28/57 [49.1%] in UVC(+) vs. 114/130 [87.7%] in UVC(-); p < 0.001). However, MRB patency at discharge (25/28 [89.3%] in UVC(+) vs. 106/114 [94.7%] in UVC(-); p = 0.3) was equally high in both groups.
Conclusion:
Our results indicate that a history of UVC is not a contraindication to MRB. Half of the patients were able to successfully receive an MRB. Patients with symptomatic PHT from EHPVO should not be excluded from consideration for MRB based on UVC history.
