The authors are to be congratulated on their excellent documentation of the 50-year evolution of portal hypertension surgery in their unit. They have performed 1000 operations. For elective long-term management, they currently favor portal flow–preserving procedures, particularly the distal splenorenal shunt, and when not possible, an extensive 2-stage Sugiura devascularization operation. They have abandoned emergency shunt surgery for acute variceal bleeding.
They do not document which patients should be selected for endoscopic therapy rather than surgery nor the number of similar good-risk patients who were treated by endoscopic therapy at their institution. Even though the article is an analysis of their surgical experience, the role of nonsurgical therapy needs to be clarified.
Terblanche J. The Evolution of Portal Hypertension Surgery—Invited Critique. Arch Surg. 2000;135(12):1394. doi:10.1001/archsurg.135.12.1394