Experience in community hospitals with nonshunting procedures for bleeding esophageal varices

The purpose of this review is not to delineate guidelines for the selection of shunting vs. nonshunting procedures in cases of esophageal bleeding due to varices and portal hypertension. The final choice made by the surgeon who is confronted with this problem is often influenced by his personal preferences and outlook. Our own view, based on limited experience, suggests that where sclerotherapy is not available or has failed, and in cases where the surgeon has to deal with a poor-risk patient, nonshunting operations such as the McDermott or the Chaube type of devascularization are the easiest and least time-consuming to perform, and hence the most promising for low operative and postoperative mortality. This is especially so when a surgeon has to be satisfied with the best available in a community hospital.