The Rex Shunt Procedure for Portal Hypertension

The Rex Shunt procedure is a relatively new treatment procedure for portal hypertension that has been performed on children with positive results.  According to what I have learned, there are now over 90+ children in North America who have had the operation.

The Rex Shunt procedure has primarily been performed at Children’s Memorial Hospital in Chicago, Illinois by Dr. Riccardo Superina.   (There maybe a few other places in the world where this procedure is being performed, but I was unable to glean that information at this time).  If you are aware of any other locations please feel free to post your comments below.

Dr. Superina explains the procedure in the video below …

What is the Rex Shunt Procedure?

On the Facebook blog I subscribe to,  a fellow member had asked Dr. Superina directly whether or not the procedure could be performed on adults, and this was his reply …

“There is no reason that it cannot be applied to adults, and we would be happy …to hear their cases if they wished to send case summaries along and recommend further investigation or action.”

If you wish to send a case summary to Dr. Superina his mailing address is:

Riccardo Superina, MD

2300 Children’s Plaza, Box 57

Chicago, IL 60614-3363

Considering my particular case, the verdict is still out as to whether doctors would even consider a procedure such as this, or for that matter any kind of operation due to my underlying clotting condition?   For you though, or possibly someone you know maybe this procedure is something worth pursuing?

I had the privilege yesterday of meeting (via the web) Shelly Hart whose daughter Aubree had the Rex Shunt procedure performed by Dr. Superina 2 1/2 years ago.  Shelly has granted me permission to post her blog and you may view it by clicking here: Please click on Aubree’s health updates to view her personal journey!  Thank you Shelly!

If you have a story to share regarding the Rex Shunt procedure or for that matter any other procedure your post is most welcome here!

See a case report of the Rex Shunt Procedure for Adults.

88 thoughts on “The Rex Shunt Procedure for Portal Hypertension

  1. J.

    Our son had his meso Rex shut surgery thirteen years ago when he was eight, and is finishing up college on his own today. He has not had to take any immunosuppressant drugs, just half a baby aspirin a day. We were lucky to have the best of all possible results, and are thankful for the skill and persistence of the local Children’s Healthcare hospital doctors and staff. Together we ruled out other possible causes to arrive at this treatment following a series of near-fatal bleed outs over a few hours’ time from esophageal varices, with ascites and splenomegaly. (Watch the bilirubin count in the blood work.) Process of elimination over the course of many weeks of tests and one ultrasound with a slightly visible extra hepatic vein were our only other clues.

    We call his jugular scar his “Harry Potter” scar, as thanks to some skilled stitching, it is rarely noticeable except when it turns red to warn he is tired or dehydrated. The chest incision now looks like a chiseled six-pack when he does not wear a shirt.

    We are very, very thankful. I write to provide hope to other readers here during their own dark, fearful times, since we were apparently one of the earliest to have this procedure done in the USA. For us at that time, deciding to perform such an invasive surgery upon our child based largely upon a diagnosis-through-process-of-elimination was the most difficult part, although the subsequent biopsies and surgery, and home-schooling recovery time had their own challenges.

    My advice is to try to remain calm and to stay strong for your child, and try to maintain some “normal” things (like reading them a bedtime story) during and after hospitalization. You may find it helpful to read all you can about the abnormal hints in your child’s chart to be the best health advocate for them that you can be. Document symptoms, dates, times and blood work changes to google later if you can. Our doctors advised us after our child recovered, to avoid contact sports, bicycling, and over-heating; it is also very important for them to always stay hydrated to prevent future injury. You may wish to keep a chronological record of doctors notes, ultrasound images, and test results, if you can, to help explain things to your child as they grow older, and as doctors change. Many doctors and hospitals have never heard of the procedure, so it is helpful to know how to explain it. God bless you all, and your doctors.

  2. Jean de Ville de Goyet

    The story of the MesoRex bypass started in the early nineties, in the context of liver transplantation in fact (as thrombosis of the portal vein was a frequent problem in liver transplanted children).
    (de Ville de Goyet J, Clapuyt P, Otte JB. Extrahilar mesenterico-left portal shunt to relieve extrahepatic portal hypertension after partial liver transplant. Transplantation. 1992;53(1):231-232.)

    Rapidly after the first case however, it expanded as a cure for non-transplanted children with idiopathic extra hepatic portal hypertension. The first serie was published in 1998.
    (de Ville de Goyet J, Alberti D, Clapuyt P, et al. Direct bypassing of extrahepatic portal venous obstruction in children: a new technique for combined hepatic portal revascularization and treatment of extrahepatic portal hypertension. J Pediatr Surg. 1998;33(4):597-601. doi:10.1016/s0022-3468(98)90324-4)

    From then onwards, the technique has been used in a growing number of countries.
    It is now considered as a real cure when feasible, and is the gold standard treatment in cases with a favorable anatomy.

    1. Clint Post author

      Dr.Goyet, Thank you for your very valuable input on this subject. Since starting this blog in 2007, I have heard your name mentioned more than once for your expertise and the success you have seen.

      Please know that the people on this blog benefit greatly by having simeone give them a glimmer of hope with this disconcerting condition. You are most welcome to post here anytime on any new developments in your specialty.

      Thanks again,



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