Promises! Promises! Hemodynamics and Portal-Systemic Shunt

Abstract

A spate of recent articles in the surgical journals^{1 2 3 4 5} reminds us of the unfulfilled promises of splanchnic hemodynamic measurements in selection of patients for portal–systemic shunt. The various operations are clearly effective in prevention of variceal hemorrhage. Operative mortality is reasonable, considering the serious liver disease usually present, technical failures are rare, and, though esophageal varices do not always disappear after operation, blood flow in them must be greatly reduced since re-bleeding is infrequent. Patients with alcoholic liver disease who stop drinking often do remarkably well for many years after the operation. However, in 15 to 30 per cent of . . .