Surgery for portal hypertension

Now that endoscopic sclerotherapy is available, the rôle of surgery in portal hypertension needs to be reconsidered. Emergency treatment of bleeding esophageal varices is based on sclerotherapy, which has widely replaced such surgical procedures as emergency portocaval shunts. Sclerotherapy can be extended to repeated endoscopic sclerosis as definitive management to prevent recurrence of variceal bleeding. Only if varices cannot be treated adequately by sclerotherapy, or in the case of local complications are surgical measures of decompression indicated. For "Child C" patients gastric devascularization or transsection should be considered. For "Child A" or "Child B" patients, distal splenorenal shunts or portocaval shunts should be given preference.