The article by Collins and coworkers is very interesting and several aspects of it deserve special mention. His group is interested in the management of portal hypertension and they take note of the importance of offering surgical treatment only in an elective fashion and to those patients with good liver function—a lesson we have learned with time.
There is no doubt as to the theory on which they base their surgical procedure; however, our attention is drawn to the fact that they indiscriminately use either 8- or 10-mm grafts. Our own group has published a prospective study comparing distal splenorenal shunts with mesocaval interposition of a 10-mm graft.1 Results of our study were not as encouraging as those obtained by Collins regarding graft permeability and postoperative encephalopathy (19% and 38%, respectively). One might argue that our patients received a slightly different operation than the one described by Collins et al; however, the same hemodynamic principles apply and the same vascular graft was used and our experience still showed an increased loss of portal blood flow.
Orozco H, Mercado MA. Partial Portacaval Shunt for Variceal Hemorrhage—Invited Commentary. Arch Surg. 1998;133(6):594. doi:10.1001/archsurg.133.6.594