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Review
. 2022 Apr 25:10:868582.
doi: 10.3389/fped.2022.868582. eCollection 2022.

Technical Aspects and Considerations of Meso-Rex Bypass Following Liver Transplantation With Left Lateral Segment Grafts: Case Report and Review of the Literature

Christina Dalzell  1 , Paola A Vargas  2 , Kyle Soltys  2   3 , Frank Di Paola  2 , George Mazariegos  2   3 , Nicolas Goldaracena  2
Affiliations
Review

Technical Aspects and Considerations of Meso-Rex Bypass Following Liver Transplantation With Left Lateral Segment Grafts: Case Report and Review of the Literature

Christina Dalzell et al. Front Pediatr. .

Abstract

In pediatric patients with extrahepatic portal vein obstruction and complications of portal hypertension, but with normal liver function, a meso-Rex bypass (MRB) connecting the superior mesenteric vein to the intrahepatic left portal is the favored surgical management. Pediatric patients with a history of a partial liver transplant (LT), especially living donors, are at greater risk for portal vein complications. Hence, an adequate knowledge of this technique and its additional challenges in the post-LT patient setting is crucial. We provide an overview of the available literature on technical aspects for an MRB post-LT. Preoperative considerations are highlighted, along with intraoperative considerations and postoperative management. Special attention is given to the even-more-demanding aspect of performing an MRB post-liver transplantation with a left lateral segment. Surgical alternatives are also discussed. In addition, we report here a unique case in which this surgical technique was performed on a complex pediatric patient with a history of a living-donor LT with a left lateral segment graft over a decade ago.

Keywords: extrahepatic portal vein obstruction (EHPVO); left lateral segment graft; living donor liver transplant (LDLT); meso-Rex bypass; pediatric surgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Schematic representation of an MRB creation. (A) Meso-Rex post-LT with whole liver grafts. (B) Meso-Rex post-LT with partial grafts (LLS). IJV, internal jugular vein; IMV, inferior mesenteric vein; IVC, inferior vena cava; LHV, left hepatic vein; LPV, left portal vein; MHV, middle hepatic vein; RHV, right hepatic vein; RPV, right portal vein; SMV, superior mesenteric vein; SV, splenic vein.
FIGURE 2
FIGURE 2
Important steps during an MRB creation. (A) Identification of the hilar structures. (B) Exposure of the left IJV. (C) Anastomosis of the left portal vein and proximal end of the left IJV.
FIGURE 3
FIGURE 3
Portal venography via the anastomosed graft with evidence of good flow into the liver.
See this image and copyright information in PMC

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