Variceal hemorrhage: surgical therapy

Surgical options for management of variceal hemorrhage include portosystemic shunts (nonselective and selective), nonshunting operations, and hepatic transplantation. In most centers, operations that preserve hepatic portal perfusion (selective shunt and nonshunting operations) have replaced nonselective shunts as the most commonly performed surgical procedures. The results of multiple controlled trials suggest that the frequency of postshunt encephalopathy is less after the distal splenorenal shunt than after the nonselective shunts. Hepatic transplantation should be considered as initial therapy for nonalcoholic cirrhotics and abstinent alcoholic cirrhotics with variceal hemorrhage or advanced liver disease and without contraindications.