Subtotal splenectomy and portal variceal disconnection in the treatment of portal hypertension.

Bleeding gastroesophageal varices caused by portal hypertension can be treated successfully by subtotal splenectomy and central splenorenal shunting. However, in elderly patients and those at high risk of hepatic failure, congestive heart failure and encephalopathy or when splenorenal anastomosis is impossible, an alternative is subtotal splenectomy and portal variceal disconnection. The author reports on the first nine patients who underwent this procedure and describes the operative technique. Complications of the operation were minimal. One patient had thrombocytosis, but this was controlled clinically. No patient experienced encephalopathy during a follow-up ranging from 10 months to 8 years. No rebleeding was noted in seven of the patients, but two had a bleeding duodenal ulcer, which was treated successfully. Liver function was preserved in all patients. These results have encouraged the author to continue investigation of subtotal splenectomy and portal variceal disconnection.