Evaluation of Venous Shunt Surgery in Portal Hypertension

The surgical treatment of portal hypertension has depended primarily on the use of portacaval or splenorenal shunts.^1-13 The shunt procedures are usually performed in patients who have hemorrhaged from esophageal varices, the surgery being done during a quiescent period. The use of balloon tamponade has been the most universal method of controlling the acute bleeding from esophageal varices.¹⁴ Recently, however, portacaval shunts have been recommended as an emergency procedure in acutely bleeding patients.¹⁵ Difficulty in the management of these patients, particularly the cirrhotic patient, has led to the introduction of various other procedures, such as gastroesophageal reaction,^16,17 transection of the upper stomach with resuturing,^18,19 and transesophageal ligation of varices.^20-22 Ligation of arterial supply to the liver and spleen has also been advocated by some.^23-26 Much of the difficulty in comparing mortality of surgically and medically treated patients is the great influence exerted on