Bleeding Varices Due to Cirrhosis: Survival After (1) Nonsurgical Treatment, (2) Splenectomy With or Without Omentopexy, and (3) Portacaval and Splenorenal Shunts

Evidence exists that splenorenal and portacaval shunts decrease the frequency and severity of bleeding from esophagogastric varices in patients who have cirrhosis of the liver.^2,3,6,7,12 It has been more difficult to evaluate the effectiveness of these operations in prolonging the lives of such patients.^3,7,13

General Background  Several studies have shown the seriousness of bleeding from the gastrointestinal tract in patients with cirrhosis of the liver. Ratnoff and Patek,¹⁶ as well as Nachlas and associates,¹³ found that only 28% of such patients survived for one year after the first hemorrhage. Douglass and Snell⁵ found that 54% survived at least one year after the first episode of bleeding; however, the circumstances of their practice demanded that most of their patients had to survive the first hemorrhage in order to reach them. The fate of those who survived the first year was more encouraging. From the end of