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June 1957

Evaluation of Venous Shunt Surgery in Portal Hypertension

AMA Arch Surg. 1957;74(6):959-963. doi:10.1001/archsurg.1957.01280120137016

The surgical treatment of portal hypertension has depended primarily on the use of portacaval or splenorenal shunts.1-13 The shunt procedures are usually performed in patients who have hemorrhaged from esophageal varices, the surgery being done during a quiescent period. The use of balloon tamponade has been the most universal method of controlling the acute bleeding from esophageal varices.14 Recently, however, portacaval shunts have been recommended as an emergency procedure in acutely bleeding patients.15 Difficulty in the management of these patients, particularly the cirrhotic patient, has led to the introduction of various other procedures, such as gastroesophageal reaction,16,17 transection of the upper stomach with resuturing,18,19 and transesophageal ligation of varices.20-22 Ligation of arterial supply to the liver and spleen has also been advocated by some.23-26 Much of the difficulty in comparing mortality of surgically and medically treated patients is the great influence exerted on

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