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Commentary
March 1, 2007

Rise and Downfall of the Empire of Portal Hypertension Surgery

Arch Surg. 2007;142(3):219-221. doi:10.1001/archsurg.142.3.219

Frequently in life, there are things that appear in a coincidental way that tend to completely modify the environment of the human being. In the same way in other occasions, forces that had taken many years to show their utility for human beings tend to disappear without a clear explanation.

Nobody, not even Eck in 1877,1 thought that ligation of the portal vein in a dog with a communication previously done between this vein and the inferior vena cava would result in the dog not dying despite the ligation if the venous blood flow was shunted before it (Eck operated on 8 dogs and 7 died). Meanwhile, Lautenbach2 in the United States described the death of dogs with the ligation but without derivation; both Lautenbach and Eck were doing research on ascitis, but Eck was the one who demonstrated “without intention” the importance of free blood flow by doing that shunt, the importance of the portal blood flow to the liver, and the importance of collateral circulation. At the same time, he opened the road for an excellent surgical treatment to hemorrhagic portal hypertension that would not be used until more than 50 years later.3

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