Portacaval Shunt for Portal Hypertension

SOME form of portacaval shunting continues to be widely used for the treatment of bleeding from esophageal varices, and to a lesser extent, for ascites, in portal hypertension due to cirrhosis. Controversy exists on many aspects of this subject.1-3The operation has been frequently challenged as to its effectiveness and criticized for its use in the past in selected good risk patients rather than those with severely impaired hepatic disease who die of the initial or a subsequent hemorrhage. Ratnoff and Patek4in 1942 and Baker et al5and Garceau and Chalmers6more recently have shown that despite improved medical treatment the survival figures of patients after variceal hemorrhage are essentially unchanged. About 20% to 50% of patients with bleeding varices survive one year and less than 20% five years. With increasing experience in this field, many surgeons have liberalized the criteria for operation, fully realizing