Graft-to—Superior Mesenteric Vein Anastomosis for Mesocaval Shunts

To the Editor.—One of us (D.E.M.) was a member of a surgical team that gave lectures and performed demonstration operations in eight teaching hospitals in the People's Republic of China. On performing the H-graft mesocaval shunt, it was found that the Dacron graft made in China is quite stiff. This stiff graft, when anastomosed in the usual fashion to an ellip> Fig 1.—Usual anastomosis of Dacron graft to superior mesenteric vein for H-graft mesocaval shunt. Note elliptical narrowing of anastomosis. Fig 2.—Improved anastomosis formed by graft bevel-to-wedge incision in superior mesenteric vein for H-graft mesocaval shunt. Note that venous pressure tends to widen, rather than narrow, lumen of anastomosis. 30° Wedge 45° Bevel tical longitudinal incision in the thickened wall of the mesenteric vein for cases of cirrhosis due to schistosomiasis, resulted in a lumen that was narrowed transversely (Fig 1). It was found that this narrowing could be