The portacaval shunt: Is it still indicated?

B. A. Levine, K. R. Sirinek

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

This article has attempted to question whether the more recently introduced methods of treating the patient with variceal hemorrhage have resulted in higher salvage rates and a better quality of life. Data concerning other types of central shunts, selective shunting, nonshunt operations, hepatic transplantation, sclerotherapy, and pharmacologic manipulation have all been critically reviewed. It seems clear that, although some of these modalities are roughly equivalent to portacaval shunting, others are inappropriate. This is especially so in the majority of patients with portal hypertension in the United States whose cirrhotic etiology is based on alcohol addiction. Additionally, a large, one-institution series of side-to-side portacaval shunts has been presented that yielded good results. It is hoped that this presentation has succeeded, at a minimum, in causing the reader to question the basis of treatment for variceal hemorrhage and, at a maximum, in convincing him or her to retain the portacaval shunt as a mainstay in treating the hemorrhagic complications of portal hypertension.

Original languageEnglish (US)
Pages (from-to)361-378
Number of pages18
JournalSurgical Clinics of North America
Volume70
Issue number2
DOIs
StatePublished - Jan 1 1990

ASJC Scopus subject areas

  • Surgery

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