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August 1993

The History of the Surgical Treatment of Portal Hypertension

Author Affiliations

From the Department of Surgery, University of California, Davis—East Bay, Oakland and the Shiley Heart Valve Research Center, Irvine, Calif.

Arch Surg. 1993;128(8):925-940. doi:10.1001/archsurg.1993.01420200099018

The history of the surgical treatment of portal hypertension is pockmarked by abbreviated observation of a small series2 and sometimes resounding pessimism,3,4 but sporadic success with a myriad of techniques,1 refurbishment of once-abandoned procedures,5,6 and occasional innovation7,8 have kept it going forward. Perhaps intrahepatic portosystemic endovascular stents introduced percutaneously through the internal jugular vein will remain patent and become widely used. The technique is minimally invasive, and so far results in eight patients have been quite encouraging.8

According to Whipple,5 normal portal pressure varies from 8 to 13 mm Hg. Portal hypertension, defined as chronic elevation above this level, is caused in some instances by extrahepatic thrombosis, but more commonly by intrahepatic presinusoidal or postsinusoidal obstruction. The simple causal relationship of increased pressure brought about by increased resistance is immediately confounded by manifold circulatory alterations focused at first in the splanchnic viscera, including

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