Direct side-to-side portacaval anastomosis is employed exclusively in our institution to control variceal hemorrhage regardless of previous operative history. A consecutive, unselected group of 152 such patients was reviewed to ascertain the effect of previous major abdominal operation on operative difficulty and outcome. Fifty patients, with previous operations ranging from biliary and gastric procedures to thrombosed distal splenorenal shunts, were compared with 102 previously unoperated patients. This comparison led to the conclusions that side-to-side direct portacaval anastomosis may be carried out in patients with a previous major abdominal operation without an increased risk in mortality or morbidity, and that although intraoperative blood loss and transfusion requirements were increased in previously operated patients, these factors (along with operative time) could be minimized by use of intraoperative vasopressin and electrocautery. Thus, alternative shunting procedures, with their increased thrombosis and rebleeding rates, need not be considered in such patients.
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