In Reply.—The comments by Drs Henderson and Millikan are interesting, but partly unjustified and erroneous. After DSRS, most of our patients continue to have prograde portovenous blood flow. However, this finding does not totally contradict the observations made after mesocaval or side-to-side portacaval shunt: liver perfusion via portal vein has been demonstrated in some patients after mesocaval shunt1; portovenous blood flow to the liver has been maintained in some patients after side-to-side portacaval shunt. We agree with Drs Henderson and Millikan that the patient's clinical course must be the final arbiter: two recent controlled trials have failed to demonstrate any advantage of DSRS over the conventional portacaval shunts.2,3
BELGHITI J, GRENIER P. Long-term Portal Perfusion Following Distal Splenorenal Shunt-Reply. Arch Surg. 1982;117(7):984. doi:10.1001/archsurg.1982.01380310089030
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