Portacaval shunt in cirrhosis of the liver: Clinical and hemodynamic aspects☆

Abstract The clinical details of 230 patients with cirrhosis of the liver upon whom a portacaval shunt was performed during the years 1947 to 1962 are recorded. Operative mortality was 14 per cent for the entire series; 12 per cent followed elective surgery and 32 per cent followed emergency surgery; there were no deaths after prophylactic surgery. Postshunt encephalopathy developed in 11 per cent, peptic-ulcer in 7 per cent and late bleeding in 7 per cent of those that survived surgery. Of the 128 patients available for analysis of five year survival, 56 per cent survived for this or a longer period. Analysis of patients over the age of fifty years, revealed little difference from those of the entire group. Emergency portacaval shunt is endorsed with the recommendation that patients with acute varical bleeding be managed similar to those with acute peptic ulcer bleeding. From the data presented, continuation of a policy for prophylactic portacaval shunt, as outlined, is recommended. On the basis of operative facility, hemodynamic data obtained during and after surgery, and a clinical comparison of two similar groups, it is concluded that the preferable portacaval anastomosis is the end to side.