[Surgical treatment of segmental extrahepatic portal hypertension].

The authors analyse the immediate and late-term results of surgical treatment of 39 patients who underwent 50 operations for segmental extrahepatic portal hypertension (SEPH). The threat of gastric hemorrhage was the main indication for surgery. Gastrotomy with suturing of the varicose veins of the stomach is the operation of choice when gastric hemorrhage continues. This operation produces an immediate clinical effect but fails to ensure long-term prevention of bleeding. In planned treatment splenectomy is the operation of choice only in patients with signs of marked hypersplenism when there is little threat of the development of asplenic thrombocytemia in the postoperative period. Separation of the vascular gastrosplenic connections is the operation of choice in the absence of hypersplenism. Ligation of the splenic artery and transposition of the decapsulated spleen into the retroperitoneal space have no haemostatic effect and must not be conducted for the prevention of gastric hemorrhage in this pathological condition.