SURGERY IN PORTAL-HYPERTENSION - WHICH PA TIENT AND WHICH OPERATION

A prospective trial of a cohort of patients (N = 94) with portal hyper tension and history of bleeding was selected for surgery based on stri ct clinical and laboratory criteria. All of them were treated with por tal blood flow preserving procedures. The following selection criteria were used: good cardiopulmonary function without pulmonary hypertensi on and good liver function (Child-Pugh A). All patients were operated in an elective fashion and the operations performed were: selective sh unts (N = 38) (distal splenorenal and splenocaval), low diameter mesoc aval shunts (N = 13) and the esophagogastric devascularization with es ophageal transection (Sugiura-Futagawa) (N = 43). Patients were select ed for each operation according to their anatomical conditions. Sixty- one of the patients were cirrhotics. Operative mortality was 8% and re bleeding was observed in 5% of the cases. Postoperative encephalopaty was seen in seven patients (three selective shunts, two low diameter m esocaval shunts and two devascularizations). In 13 of 62 patients post operatively evaluated by means of angiography, portal vein thrombosis was shown (seven selective shunts, two low diameter shunts and four de vascularizations). Twenty-two patients with preoperative portal vein t hrombosis (and treated with a Sugiura-Futagawa operation) were exclude d from postoperative angiographic evaluation. Survival (Kaplan-Meier) was 85% at 60 months. Portal blood flow preserving procedures are the treatment of choice for patients with hemorrhagic portal hypertension and good liver function. The kind of operation is selected according t o the individual anatomical status of the patient.