[The value of laparoscopy in the study of portal hypertension]

Up to now, laparoscopy has always been considered as only marginally importan in the study of portal hypertension whereas in fact it should become one of the fundamental examinations in this field. The technique not only contributes, by direct liver exploration, to a more precise judgment regarding the underlying disease, with the possibility of earlier recognition of pre-hepatic, intra-hepatic and post-hepatic forms of portal hypertension, but also makes it possible to detect the earliest signs of hypertension. Further, and most important, laparoscopy extends investigation of the collateral circulation to the sector of the small peritoneal vessels which are inaccessible with other techniques, demonstrating alterations are of decisive importance in the economy of the collateral circulation. On the basis of these new elements, together of course with radiological and fibro-endoscopic data, it is possible to divide cases of portal hypertension into three groups depending on the type of collateral circulation operative on each occasion. These types present differing anatomcfunctional features and clinical physiognomy, a factor of great practical importance especially for the purpose of establishing indications for the portacaval anastomosis of choice, and possibly prophylactic intervention.