Rex shunt, which was first put in use in 1992, has been considered as an ideal surgical method for the treatment of extra-hepatic portal venous obstruction (EHPVO) due to its reconstruction of the hepatopetal portal blood flow. However, despite its long tradition, there are only a few reports about the application and advances in Rex shunt for the treatment of EHPVO in children. In this paper, we summarized the literature related to Rex shunt and discussed the new advances of Rex shunt in the following aspects: surgical method of Rex shunt, the indications of Rex shunt, the strengths of Rex shunt, the effectiveness of Rex shunt, factors affecting the efficacy of Rex shunt, methods that improve the prognosis of Rex shunt, and treatment strategy for recurrence after Rex shunt.

Background: To evaluate the effectiveness and safety of endoscopic decompression with a transanal drainage tube (ED-TDT) in the treatment of neonatal Hirschsprung's disease (HD). Materials and Methods: Six newborns (4 boys and 2 girls; age at operation 9–29 days, median 24 days) were admitted to our hospital due to the delayed passage of meconium after birth, abdominal distension, and vomiting. HD was diagnosed by the retrograde enema radiography. All patients underwent ED-TDT for decompression of the dilated colon. During the operation, an endoscope was inserted through the anus to the ascending colon or ileocecal region, which was then used to insert a guidewire to the ascending colon. The endoscope was then removed, and a colorectal drainage tube was introduced over the guidewire. This drainage was placed until a pull-through procedure was performed. Results: The ED-TDT was successfully performed in all newborns. The intraoperative rectal biopsy confirmed the diagnosis of HD. The duration of the operation was 25–70 minutes (median 52.5 minutes). There were no perforations, bleeding, or other complications after surgery. After surgery, the abdominal distention was significantly relieved, and the babies could be fed with milk after 6 hours. These babies were discharged after 2–11 days (median 2.5 days) and underwent a pull-through procedure after 1–3 months (median 3 months). Conclusions: ED-TDT is a safe and effective treatment for neonatal HD before a pull-through procedure. It could be used as an alternative therapy to colostomy.

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.