{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T13:52:35Z","timestamp":1788357155999,"version":"build-2803163510"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T00:00:00Z","timestamp":1740960000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>The Meso-Rex bypass (MRB) provides a physiological cure for EHPVO by restoring hepatopetal flow, effectively reducing portal pressure. We share our experience with the MRB procedure, its outcomes, and challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>To describe the feasibility and effectiveness of MRB in children with EHPVO in our practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>This is a retrospective study of children with EHPVO who underwent MRB between January 2013 and May 2024. MRB was considered in patients with asymptomatic splenomegaly, moderate hypersplenism, and patent left portal vein either on Doppler or contrast-enhanced computed tomography. The internal jugular vein was used in all cases as jump graft. At follow-up, Doppler was done to note the patency of the shunt and size of the spleen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Eighty-two shunts of all types were performed. MRB was considered in 17 patients (21%) as per preoperative criteria. MRB was possible in only 10 (12%). Data were analyzed for these 10 children. The average age was 4.5 years (range 1\u201311 years), 7 were &lt;5 years. Presentation included hematemesis (eight children) and splenomegaly (two children). Four had moderate hypersplenism. Two developed transient self-limiting ascites in early postoperative period. There were no other immediate perioperative complications. The average duration of follow-up was 67 months. One child had hematemesis 2 years after surgery due to stenosis at the proximal end of graft which was treated with endovascular dilatation. Hypersplenism resolved in all children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>MRB is the only curative option for EHPVO. It is feasible in a small subset of patients. Outcomes of MRB are good, especially in younger children.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jiaps.jiaps_305_24","type":"journal-article","created":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T08:00:11Z","timestamp":1741075211000},"page":"351-355","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Meso-Rex Bypass: Insights from a Single-center Experience in India"],"prefix":"10.4103","volume":"30","author":[{"given":"Sanjay","family":"Rao","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. M.","family":"Zameer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Pallav","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Rakhesh","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinay","family":"Chandrashekar","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"D\u2019Cruz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,3,3]]},"reference":[{"key":"R1-20250505","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.1016\/j.jamcollsurg.2013.10.024","article-title":"Meso-rex bypass \u2013 A procedure to cure prehepatic portal hypertension: The insight and the inside","volume":"218","author":"di Francesco","year":"2014","journal-title":"J Am Coll Surg"},{"key":"R2-20250505","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1053\/j.sempedsurg.2012.05.005","article-title":"Surgical management of portal hypertension in children","volume":"21","author":"de Ville de Goyet","year":"2012","journal-title":"Semin Pediatr Surg"},{"key":"R3-20250505","first-page":"272","article-title":"Mesoportal bypass for extrahepatic portal vein obstruction in children: Close to a cure for most!J Pediatr 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Disord"},{"key":"R10-20250505","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.surg.2008.12.004","article-title":"Recanalized umbilical vein conduit for meso-rex bypass in extrahepatic portal vein obstruction","volume":"145","author":"Facciuto","year":"2009","journal-title":"Surgery"},{"key":"R11-20250505","first-page":"213","article-title":"Mesenterico-left portal vein bypass in children with congenital extrahepatic portal vein thrombosis: A unique curative approach","volume":"36","author":"Fuchs","year":"2003","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"R12-20250505","first-page":"297","article-title":"Rex shunt for extra-hepatic portal venous obstruction in children","volume":"9","author":"Zhang","year":"2022","journal-title":"Children (Basel)"},{"key":"R13-20250505","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1007\/s00383-021-04986-z","article-title":"Meso-rex bypass versus portosystemic shunt for the management of extrahepatic portal vein obstruction in children: Systematic review and meta-analysis","volume":"37","author":"Yamoto","year":"2021","journal-title":"Pediatr Surg Int"},{"key":"R14-20250505","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jvir.2011.11.030","article-title":"Outcomes of percutaneous interventions for managing stenosis after meso-rex bypass for extrahepatic portal vein obstruction","volume":"23","author":"Lautz","year":"2012","journal-title":"J Vasc Interv Radiol"},{"key":"R15-20250505","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.jpedsurg.2005.10.059","article-title":"Effectiveness of rex shunt in the treatment of portal hypertension","volume":"41","author":"Dasgupta","year":"2006","journal-title":"J Pediatr Surg"}],"container-title":["Journal of Indian Association of Pediatric 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