Clinical Comparison of End-to-Side and Side-to-Side Portacaval Shunt

THE portacaval shunt is now widely used in the treatment of portal hypertension in chronic liver disease. Though its effect on longevity remains to be proved it is well established that a portacaval shunt is effective in preventing hemorrhage from esophageal varices. Since Longmire and his colleagues1 showed, in 1958, that a side-to-side portacaval anastomosis was technically feasible, there has been uncertainty whether the side-to-side or the end-to-side procedure was preferable. It has been proposed that the former is superior for the treatment of refractory ascites2 though operative mortality has been high in most of the published reports.3 A good . . .