PROPHYLACTIC PORTACAVAL ANASTOMOSIS IN CIRRHOTIC PATIENTS WITH ESOPHAGEAL VARICES AND ASCITES - EXPERIMENTAL DESIGN AND PRELIMINARY RESULTS

Prophylactic portacaval anastomosis has not increased survival in unselected cirrhotic patients despite virtual elimination of variceal hemorrhage as a cause of death. Analysis of previous studies suggested that cirrhotic patients with ascites are especially susceptible to hemorrhage from varices. The present investigation was undertaken to determine whether prophylactic portacaval anastomosis will increase survival in cirrhotic patients with ascites. Preliminary results in seventy cirrhotic patients with esophageal varices and ascites after forty months of investigation have suggested (1) that cirrhotic patients with ascites are particularly prone to bleed from varices; (2) that prophylactic portacaval shunts can be accomplished in these patients with acceptably low operative mortality; and (3) that the incidence of variceal hemorrhage and death can be decreased by portacaval shunts. More patients and prolonged followup periods will be necessary to establish the role of prophylactic portacaval anastomosis in selected cirrhotic patients with increased risk of hemorrhage from varices. © 1969.