[Portal hypertension with special reference to liver hemodynamics. Shunt surgery as the method of choice]

We do not know a common good concept of the therapy of portal hypertension. The usual practised types of portosystemic shunt procedures after hemorrhage from esophageal varices can lead to hepatic failure as a result of reduced portal perfusion. If a high proportion of portal blood flow in liver perfusion is found, only an incomplete procedure of portal decompression with a Warren-shunt is indicated. Paying attention to the proportion of arterioportal perfusion of the liver and different choice of operative procedures, a better selection of patients and "shunting" will be possible. Animal studies with an "organohepatopexy" for prehepatic occlusion as well as the ligature of the splenic artery in hypersplenism show in selected cases little steps in the treatment of portal hypertension.