Analysis of Forty-Two Shunt Procedures for Portal Hypertension

Abstract

At the present time there is a considerable body of evidence in the surgical literature to support the contention that venous shunting procedures constitute an effective method of controlling hemorrhage from varices of the upper gastrointestinal tract. We are in accord with those authors^1,2,4-6,9 who find these operations useful in the management of selected patients with bleeding esophageal varices, and we wish to present an analysis of 42 operative cases from the Lahey Clinic through 1957 to support this point of view. In 28 patients splenectomy and splenorenal anastomosis were carried out. In one early case nephrectomy was necessary to effect an anastomosis. As experience with this procedure increases, however, it should rarely, if ever, be necessary to sacrifice a kidney. The eventual mortality (operative and late follow-up) in this group has been 47%. End-to-side portacaval shunts have been carried out in 13 cases, with a final mortality to