Selective Decompression of Esophagogastric Varices

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Abstract
ALTHOUGH it is acknowledged that a well-performed portacaval shunt is effective in preventing recurrent variceal hemorrhage, a degree of medical dissatisfaction with the operation is apparent. In general terms, such dissatisfaction is related to two factors. One is that no betterment of liver physiology or function results from the operative lowering of portal pressure. The other factor is that debilitating postshunt encephalopathy appears with predictable regularity after portasystemic diversion. In postnecrotic and alcoholic cirrhosis the underlying hepatic pathologic process is incurable. Shunt procedures can only be palliative, removing, as they do, the life threat of exsanguination. In such circumstances the subsequent encephalopathy has been accepted by physicians with a degree of equanimity. On the other hand, in schistosomiasis-induced portal hypertension, liver function is normal and postshunt encephalopathy is a devastating and tragic aftermath of an otherwise curative operation. An operation which could decompress esophageal varices, which would prevent recurrent gastrointestinal

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