Comparison of the major variceal decompressive operations: one surgeon's experience.

One surgeons's experience with five of the major variceal decompressive procedures is reported. Of the 69 cirrhotic patients studied, 24 were actively bleeding at operation. Overall 90 day operative mortality was 29 per cent. The highest mortality rates followed H-graft mesocaval shunt (50%), principally because of high rebleeding rates. Index of operative difficulty was greatest for distal splenorenal shunt, and postoperative ascites was a frequent problem (42%), but encephalopathy rates were least (8.3%). Portacaval shunts were most effective in prevention of variceal rehemorrhage, and the side-to-side methods best prevented postoperative ascites, but encephalopathy rates were high. It is concluded that while none of these operations is ideal, by selecting the appropriate procedure to suit the individual patient's pre- and intraoperative circumstance, the best results may be obtained.