Emergency Portal Decompression: A Review of 31 Patients Operated Upon via a Midline Approach

A hospital survival rate of 71% was obtained in 31 consecutive cirrhotic patients who underwent portal decompression during the acute bleeding episode. All patients were operated upon within 48 hours and most within six hours of the start of the hemorrhage. Patients with jaundice, ascites, or mild encephalopathy were accepted for surgery, and only patients with severe encephalopathy were rejected. There were five deaths in hospital and two late deaths from hepatic failure. Five of the surviving patients have evidence of some encephalopathy. This unfortunate complication of present techniques of portal decompression, either emergency or elective, will be diminished by techniques which allow more selective decompression. With a midline incision, portacaval, splenorenal or mesenteric renal shunts are possible and thus a preoperative splenoportogram may be avoided in the emergency situation. This experience suggests that the common policy of restricting portal decompression to those patients who have survived and recovered from their hemorrhage is unrealistic.