Surgeons today are being called upon to treat patients of all ages for portal hypertension because of its associated symptoms of gastrointestinal hemorrhage, ascites, and congestive hypersplenism. The efficacy of decompressive shunting procedures has been demonstrated repeatedly in persons with extrahepatic or intrahepatic types of portal venous obstruction.* The majority of symptomatic patients are amenable to the conventional splenorenal or portacaval shunt.
However, there remain four sizable groups of patients for whom such established procedures are impossible: (1) the "postsplenectomy bleeder" with cavernomatous changes in the portal vein itself, (2) the patient with preexistent thrombosis and recanalization of the portal vein and its major tributaries, (3) the person with excessive bleeding at surgery from periportal or perisplenic collateral vessels, and (4) the small child in whom the difficulties of obtaining an adequate-sized, patent portal-to-systemic venous shunt may be almost insurmountable. In each such case, the primary problem is that of