Purpose: Extrahepatic portal vein obstruction (EHPVO) is a major cause of portal hypertension in children. The meso-rex shunt is the recommended treatment, where a vein graft is placed between the superior mesenteric vein and the left portal vein. Given the complexity of this operation and the rarity of this condition, it has been performed in a limited number of centres worldwide. This is the first case series in Australia or New Zealand on this technique. Methodology: Data was collected retrospectively from the hospital medical records of all patients who had a meso-rex shunt for EHPVO at the Queensland Children’s Hospital. The primary outcomes collected included post-shunt technical complications, post-shunt interventions, mortality and symptom resolution. Results: 18 patients had a meso-rex shunt performed at the Queensland Children’s Hospital. The internal jugular vein was used as a graft in 77.8% (n=14) of patients. Three patients (16.7%) used another type of vein, which included the superficial femoral vein, coronary vein, and inferior mesenteric vein. In one patient no vein graft was used (5.5%). The success rate, which was defined as a patent shunt on long term follow-up, was 83.3% (n=14). The shunt thrombosis rate was 22.2% (n=4) all of which required return to theatre. Conclusion: This series demonstrates that meso-rex shunts can be an effective treatment option for the management of EHPVO in the Australian population, as supported by the wider literature. This is the first published series of patients who have undergone a meso-rex shunt in Australia or New Zealand.