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September 1971

Surgical Management of Portal Hypertension: A Ten-Year Experience

Author Affiliations

Beirut, Lebanon
From the Department of Surgery, American University Hospital and the School of Medicine, American University, Beirut, Lebanon.

Arch Surg. 1971;103(3):363-370. doi:10.1001/archsurg.1971.01350090045010

Between 1957 and 1967 a total of 50 patients underwent portal decompression for portal hypertension at the American University Hospital. Thirty-three patients were treated by portacaval anastomosis and 17 were treated by splenorenal anastomosis. The major indications for shunting were hemorrhage (66%); ascites (10%); hypersplenism (6%). The remaining 18% of patients had bleeding as well as either ascites or hypersplenism. In 90% of patients the cause of portal hypertension was intrahepatic obstruction. Patients with altered metabolic function as evidenced by decreased serum albumin, increased serum bilirubin, and elevated sulfobromophthalein retention had the poorest prognosis. The long-term follow-up of cirrhotic patients with variceal hemorrhage whose course has been altered by surgical operation shows that 44% of patients were living and well five years following their initial operation. Overall operative mortality was 18%, with hepatic coma, hemorrhage and shock, sepsis, and electrolyte imbalance making up the list of contributing factors.