The History of the Surgical Treatment of Portal Hypertension

James G. Chandler, MD
Arch Surg. 1993;128(8):925-940. doi:10.1001/archsurg.1993.01420200099018.
Text Size: A A A
Published online

The history of the surgical treatment of portal hypertension is pockmarked by abbreviated observation of a small series2 and sometimes resounding pessimism,3,4 but sporadic success with a myriad of techniques,1 refurbishment of once-abandoned procedures,5,6 and occasional innovation7,8 have kept it going forward. Perhaps intrahepatic portosystemic endovascular stents introduced percutaneously through the internal jugular vein will remain patent and become widely used. The technique is minimally invasive, and so far results in eight patients have been quite encouraging.8

According to Whipple,5 normal portal pressure varies from 8 to 13 mm Hg. Portal hypertension, defined as chronic elevation above this level, is caused in some instances by extrahepatic thrombosis, but more commonly by intrahepatic presinusoidal or postsinusoidal obstruction. The simple causal relationship of increased pressure brought about by increased resistance is immediately confounded by manifold circulatory alterations focused at first in the splanchnic viscera, including


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.