[Are surgical shunts still indicated?]

The indication for portosystemic shunts has been influenced by endoscopic approaches, liver transplantation and TIPSS. Underlying disease and functional capacity of the liver are crucial for the therapeutic strategy in patients with esophageal variceal hemorrhage. In Child B and C cirrhosis results of liver transplantation are superior to surgical shunts. In transplantation candidates shunt surgery should not interfere with the transplantation procedure. Therefore, TIPSS, mesocaval shunt or Warren shunt are recommended. If transplantation is not indicated, surgical shunts are generally justified for intractable variceal bleeding. Due to the high mortality following surgical shunts TIPSS may be preferentially used in patients with Child C cirrhosis.