Surgery and prognosis of prehepatic portal hypertension

Results of surgical treatment of prehepatic portal hypertension during the past 15 years were assessed, in addition to routine clinical and laboratory studies, by splenoportography and control mesenteric-venography. One patient survived 14 years. Control angiography of the portal system proved to be most important in assessing the results of surgical treatment, recognizing the cause of late failures and evaluating the course of the disease. All splenectomized patients with general PPH experienced recurrences of hemorrhage which required reoperation. Direct operation on the varices is a favorable procedure, particularly when done as an emergency procedure. Following surgery, early angiographic examination, especially by mesenteric-venography, is mandatory. In cases with poor portal circulation through the liver and massive passage of blood through the varices, PSA should be performed without delay. Portosystemic anastomosis is a selective procedure. Without angiographic study it is contraindicated as an emergency procedure, especially in splenectomized patients.