[Shunt surgery in portal hypertension. Pathophysiology and indications]

Portosystemic shunts are well established methods of avoiding recurrent hemorrhage from esophageal varices. Hemodynamic aspects and clinical results suggest that distal splenorenal shunts should be preferred over non-selective shunts. The functional capacity of the liver is crucial for any type of shunt. In patients with Child C cirrhosis, mortality is known to be particularly high following an emergency shunt so that, this procedure is recommended only as a rescue operation. Although prophylactic shunting decreases the risk of bleeding from varices, it leads to higher liver-related mortality. Prophylactic shunts are, therefore, indicated only in exceptional cases.