The distal splenorenal shunt represents a new approach to the surgical treatment of portal hypertension. In a report of earlier experience, the authors indicated that the fundamental objective of the operation, namely selective variceal decompression without interfering with the flow of portal blood to the liver, was accomplished. Because of the initial high mortality, they then emphasized the need to exercise caution in applying this procedure clinically. Since that time, a substantial drop in operative mortality has been achieved through several important changes in technic and in the criteria of patient selection. The current mortality of 5.5% is certainly within the acceptable limit in the surgical treatment of portal hypertension. Several patients have now been followed up for more than four yr, the longest being six yr. The additional data which have been accumulated on these patients continue to confirm the physiologic and metabolic superiority of the selective shunt. Absence of recurrent gastroesophageal bleeding and the markedly reduced incidence of encephalopathy strongly support the validity of the concept of this procedure. Long term survival data are not yet available because of the shortness of the follow up period. Whether the continued perfusion of the liver with portal blood would obviate the accelerated rate of hepatic deaths which has been reported after portacaval shunt remains to be seen. The answer to this crucial question can only be provided by the results of a prospective randomized study comparing the distal splenorenal shunt with the total portal systemic shunting procedure. Such a study is in progress at the present time.
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