The clinical effectiveness of selective portal shunts

The use of four types of selective portal shunts designed to avoid postshunt encephalopathy has been reviewed. The incidence of hospital mortality and recurrent hemorrhage from varices among 187 reported cases have been comparable to standard portacaval shunts. The incidence of postshunt encephalopathy among 154 survivors with patent shunts followed from two to ninety-six months has averaged 8 per cent but with significant differences between the types of operation. The most effective has been the left gastric vein to vena cava shunt followed by the distal splenorenal shunt, the modified central splenorenal shunt, and the central splenorenal shunt, with success in avoiding encephalopathy in direct proportion to the number and size of postoperative collaterals between the persistently hypertensive portal system and the decompressed splenic system. The development of such collaterals inlong-term survivors, especially after the splenorenal shunts, may contribute to an incidence of late encephalopathy approaching that of nonoperative patients.