Portal hypertension and shunt surgery.

Surgical shunts in the management of portal hypertension are one component of overall management. The main complications of portal hypertension is variceal bleeding. The very high mortality rate of this complication mandates careful assessment and appropriate treatment. Despite the introduction of new treatment methods such as pharmacologic reduction of portal pressure and endoscopic sclerotherapy, taken in conjunction with the coming of age of liver transplantation, surgical decompressive shunts still have a role in the overall treatment of these patients. The choice of therapy is based on full evaluation. The emphasis of that evaluation is on hepatic function. The patients who can live with their liver for an acceptable period of time and do not have the bleeding controlled with lesser medical managements require decompressive shunts. Surgical decompression of portal hypertension may also be required in the patient who is bleeding to death in the acute setting and, finally, is required for the treatment of acute Budd-Chiari syndrome. The choice of shunt procedures should take into account the potential for liver transplantation at some point in the future.