Masha: Meso-Rex Bypass Procedure for Portal Cavernoma

Her name is Masha, (fictitious name) she is eight years old, and she arrived in Palermo from Sweden where she lives with her family, to undergo delicate abdominal surgery. The little girl was suffering from portal cavernoma, a condition that involves an obstruction of a section of the portal vein and does not allow blood to flow from the intestine to the liver, causing hypertension in the portal system that frequently complicates (as in Masha's case) digestive hemorrhage.

For this reason, the child had to undergo a delicate operation. She arrived in Palermo in March 2017 to undergo bypass surgery at UPMC ISMETT using the meso-Rex technique by Dr. Jean de Ville de Goyet, head of pediatric abdominal surgery and pediatric abdominal transplants at the institute. The meso-Rex bypass is a very special technique used in very few centers and invented in 1992 by Professor de Ville himself. It is the only procedure that allows true physiologic treatment of the portal cavernoma problem.

The procedure is a true liver bypass surgery involving the joining of two veins and is normally done using the jugular vein. Masha's anatomical features, however, did not allow the jugular vein to be used, which is why it was essential to use alternative material. In Masha's case, the umbilical vein remnant was, in fact, used in an innovative way that has never been done before, combining the recanalized umbilical vein with an abdominal vein to create a bypass of suitable caliber. Never before used in the world: the new technique used by Masha allowed the meso-Rex bypass to be performed without the use of the jugular vein and with an excellent result. “The use of this new technique,” emphasizes Dr. de Ville de Goyet, “opens new perspectives and solutions for so many more children. The umbilical vein, the very one that allows the fetus to grow in the uterus for 9 months, can in these cases be put 'back in service' and make a normal life for older children.”

The child is now doing well. Her clinical condition is excellent, and she has already been able to return to her home a few kilometers from Stockholm. “We would like to thank,” little Masha's parents emphasize, “all the medical, nursing and clinical support staff for the kindness, helpfulness and professionalism that we encountered at the Institute and that accompanied us throughout this difficult journey.

Dr. de Ville de Goyet is a leader in international pediatric surgery. During his career he has performed more than 500 transplants on children, achieving results approaching 100 percent in the case of the 34 living transplants he performed in Italy. He completed his medical training between Paris and Brussels: in the latter city he began his career as a surgeon in the 1990s and became interested in pediatric transplantation and acquired expertise in split and living donor techniques that spans more than 20 years. He spent a 5-year period in Birmingham (UK) where he helped develop one of the first pediatric liver and bowel transplant centers, where he also became interested in the management of intestinal failure.

At the age of 48, he returned to Brussels with a mission to organize the Department of Abdominal Surgery and Transplantation and took the position of full professor of pediatric surgery. In Italy, he arrived in Rome in 2007 where he headed the Department of Surgery and Transplantation Center at Bambin Gesù Children's Hospital. Within 10 years, he created a new pediatric transplant center, achieving outstanding results obtained only by a small international group of pediatric transplant centers, among others: a survival curve of 96% at 7 years.

Dr. de Ville joined the medical staff at ISMETT with the goal of providing highly specialized care in the field of liver surgery to children in the Euro-Mediterranean basin.

“I came to ISMETT with a clear mission: to provide highly specialized and innovative pediatric care in the south of Italy and beyond,” Dr. de Ville de Goyet continues. “ISMETT integrates as a regional referral center dedicated to high-complexity care. This allows us to have the ability to attract patients from other regions but not only. ISMETT, in my opinion, can become in the near future a reference region for care in the Mediterranean area, both for adult patients and in the case of children.”

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