Comparative study of classic Rex shunt and modified Rex shunt in treating portal cavernoma in children

To explore the differences in efficacy and underlying reasons between the classic Rex shunt and the modified Rex shunt in treating extrahepatic portal vein obstruction (EHPVO) in children. This retrospective study compared 24 children with portal cavernomas treated at our hospital from July 2022 to March 2024. Twelve patients underwent the classic Rex shunt using an internal jugular vein as a bypass vein, whereas the other twelve patients received the modified Rex shunt involving an inferior mesenteric vein (IMV) to the left portal vein (LPV) shunt. This study compared the operative time, postoperative hospital stay, pre- and postoperative portal pressures, degree of postoperative portal pressure reduction, diameter and length of grafted vein, diameter of vascular anastomosis with the left portal vein, patency rate of the bypass vein, postoperative splenic shrinkage ratio, postoperative hypersplenism relief rate, and incidence of postoperative rebleeding between the two groups. There were no statistically significant differences in age at surgery, sex ratio, postoperative hospital stay, or follow-up duration between the two groups. The operative time for the classic Rex shunt was notably longer than that for the modified Rex shunt (P < 0.001). There were no statistically significant differences in pre- or postoperative portal pressure, degree of postoperative portal pressure reduction, length of the grafted vein, or diameter of the anastomosis with the LPV between the two groups. However, the diameter of the internal jugular vein was notably larger than that of the IMV (P < 0.001). The diameter of the bypass vein in the patency group was notably greater than that in the occluded group (P < 0.001). Compared with the modified Rex shunt group, the classic Rex shunt group had a greater postoperative hypersplenism relief rate, but this difference was not statistically significant. The patency rate of the bypass vein and the postoperative splenic shrinkage ratio were markedly greater in the classic Rex shunt group than in the modified Rex shunt group (P < 0.05). The classic Rex shunt was more effective based on a higher patency rate and greater relief of splenomegaly and hypersplenism.