Prophylactic Portacaval Anastomosis in Cirrhotic Patients with Esophageal Varices

SINCE Whipple1 and Blakemore and Lord2 introduced portacaval shunting as an effective means of portal decompression this technic has become the definitive surgical treatment of portal hypertension. Almost all investigators agree that the incidence of recurrent hemorrhage from esophageal varices in patients who have previously experienced such bleeding is sharply decreased after the construction of therapeutic portacaval shunts.3 4 5 6 7 8 9§ Furthermore, these authors believe that portal decompression decreases the overall mortality in the survivors of hemorrhage by the prevention of further bleeding. Others question its effectiveness in reducing the mortality in these patients since it is available to only the fittest . . .