Indian Journal of Surgery

, Volume 74, Issue 1, pp 55–66

Current Role of Surgery in Portal Hypertension

Review Article


Treatment for portal hypertension (PHT) has evolved from surgery being the only option during the 1970s to the wide range of options currently available. Surgery has not vanished from the therapeutic armamentarium, but its role has changed and is constantly evolving. The present review primarily focuses on the role of surgery in tackling patients with PHT and varices with regard to the Indian scenario and also looks at its relevance, given the availability of a host of other therapeutic options.


Portal hypertension Portosystemic shunt Surgery Variceal haemorrhage 


  1. 1.
    Groszmann RJ, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Planas R et al (2005) Portal hypertension collaborative group. Beta blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 353:2254–2261PubMedCrossRefGoogle Scholar
  2. 2.
    Sarin SK, Kumar A, Angus PW, Baijal SS, Chawla YK, Sahni P et al (2008) APASL working party on portal hypertension. Primary prophylaxis of gastroesophageal variceal bleeding: consensus recommendations of the Asian Pacific Association for the Study of the Liver. Hepatol Int 2(4):429–439PubMedCrossRefGoogle Scholar
  3. 3.
    de Franchis R, Baveno V Faculty (2010) Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 53(4):762–768PubMedCrossRefGoogle Scholar
  4. 4.
    Bosch J, Berzigotti A, Garcia-Pagan JC, Abraldes JG (2008) The management of portal hypertension: rational basis, available treatments and future options. J Hepatol 48(Suppl 1):S68–S92PubMedCrossRefGoogle Scholar
  5. 5.
    D’Amico G, Luca A (1997) Natural history clinical-haemodynamic correlations. Prediction of the risk of bleeding. Baillieres Clin Gastroenterol 11:243–256PubMedCrossRefGoogle Scholar
  6. 6.
    Bambha K, Kim WR, Pedersen R, Bida JP, Kremers WK, Kamath PS (2008) Predictors of early re-bleeding and mortality after acute variceal haemorrhage in patients with cirrhosis. Gut 57(6):814–820PubMedCrossRefGoogle Scholar
  7. 7.
    Rao TH, Pande GK, Sahni P, Nundy S (1991) The management of upper gastrointestinal haemorrhage in a tropical country. Arch Emerg Med 8(3):169–176PubMedGoogle Scholar
  8. 8.
    Sarin SK, Sollano JD, Chawla YK, Amarapurkar D, Hamid S, Hashizume M et al (2006) Members of the APASL working party on portal hypertension. Consensus on extra-hepatic portal vein obstruction. Liver Int 26(5):512–519PubMedCrossRefGoogle Scholar
  9. 9.
    Pande GK, Reddy VM, Kar P, Sahni P, Berry M, Tandon BN, Nundy S (1987) Operations for portal hypertension due to extrahepatic obstruction: results and 10 year follow up. Br Med J (Clin Res Ed) 295(6606):1115–1117CrossRefGoogle Scholar
  10. 10.
    Sarin SK, Bansal A, Sasan S, Nigam A (1992) Portal-vein obstruction in children leads to growth retardation. Hepatology 15:229–233PubMedCrossRefGoogle Scholar
  11. 11.
    Valla DC, Condat B, Lebrec D (2002) Spectrum of portal vein thrombosis in the West. J Gastroenterol Hepatol 17(Suppl 3):S224–S227PubMedCrossRefGoogle Scholar
  12. 12.
    Basu AK, Boyer J, Bhattacharya R, Basu Mallick KC, Sengupta KP (1967) NCPF with PHT–a new syndrome. Part I. Indian J Med Res 55:336–350PubMedGoogle Scholar
  13. 13.
    Mallick KC, Sengupta KP, Basu AK, Biswas SK, Pal NC, Boyer J (1967) NCPF with PHT–a new syndrome. Part II. Indian J Med Res 55:351–359Google Scholar
  14. 14.
    Sarin SK, Kumar A, Chawla YK, Baijal SS, Dhiman RK, Sahni P et al (2007) Members of the APASL working party on portal hypertension. Noncirrhotic portal fibrosis/idiopathic portal hypertension: APASL recommendations for diagnosis and treatment. Hepatol Int 1(3):398–413PubMedCrossRefGoogle Scholar
  15. 15.
    Sarin SK (2002) Non-cirrhotic portal fibrosis. J Gastroenterol Hepatol 17(Suppl 3):S214–S223PubMedCrossRefGoogle Scholar
  16. 16.
    Chawla Y, Duseja A (2003) Non-cirrhotic portal fibrosis (NCPF) is a vanishing disease in India. Trop Gastroenterol 24(2):45–46PubMedGoogle Scholar
  17. 17.
    Saigal S, Nayak NC, Jain D, Kumaran V, Mohanka R, Saraf N, Rastogi A, Mehta N, Nundy S, Soin A (2011) Non-cirrhotic portal fibrosis related end stage liver disease in adults: evaluation from a study on living donor liver transplant recipients. Hepatol Int [Epub ahead of print]Google Scholar
  18. 18.
    Okuda K, Obata H (1991) Idiopathic portal hypertension (hepatoportal sclerosis). In: Okuda K, Benhamou JP (eds) Portal hypertension: clinical and physiological aspects. Springer, Tokyo, pp 271–287Google Scholar
  19. 19.
    Sarin SK, Kumar A, Angus PW, Baijal SS, Baik SK, Sahni P, Asian Pacific Association for the Study of the Liver (APASL) Working Party on Portal Hypertension et al (2011) Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations. Hepatol Int 5(2):607–624PubMedCrossRefGoogle Scholar
  20. 20.
    Luca A, D’Amico G, La Galla R, Midiri M, Morabito A, Pagliaro L (1999) TIPS for prevention of recurrent bleeding in patients with cirrhosis: meta-analysis of randomized clinical trials. Radiology 212:411–421PubMedGoogle Scholar
  21. 21.
    Sugiura M, Futagawa S (1984) Esophageal transection with paraesophagogastric devascularizations (the Sugiura procedure) in the treatment of esophageal varices. World J Surg 8(5):673–679PubMedCrossRefGoogle Scholar
  22. 22.
    Hassab MA (1998) Gastro-esophageal decongestion and splenectomy GEDS (Hassab), in the management of bleeding varices. Review of literature. Int Surg 83(1):38–41PubMedGoogle Scholar
  23. 23.
    Spence RA, Johnston GW (1985) Results in 100 consecutive patients with stapled esophageal transection for varices. Surg Gynecol Obstet 160(4):323–329PubMedGoogle Scholar
  24. 24.
    Mathur SK, Shah SR, Nagral SS, Soonawala ZF (1999) Transabdominal extensive esophagogastric devascularization with gastroesophageal stapling for management of noncirrhotic portal hypertension: long-term results. World J Surg 23(11):1168–1174PubMedCrossRefGoogle Scholar
  25. 25.
    Orloff MJ, Isenberg JI, Wheeler HO, Haynes KS, Jinich-Brook H, Rapier R, Vaida F, Hye RJ (2009) Randomized trial of emergency endoscopic sclerotherapy versus emergency portacaval shunt for acutely bleeding esophageal varices in cirrhosis. J Am Coll Surg 209(1):25–40PubMedCrossRefGoogle Scholar
  26. 26.
    Prasad AS, Gupta S, Kohli V, Pande GK, Sahni P, Nundy S (1994) Proximal splenorenal shunts for extrahepatic portal venous obstruction in children. Ann Surg 219(2):193–196PubMedCrossRefGoogle Scholar
  27. 27.
    Mitra SK, Rao KL, Narasimhan KL, Dilawari JB, Batra YK, Chawla Y et al (1993) Side-to-side lienorenal shunt without splenectomy in noncirrhotic portal hypertension in children. J Pediatr Surg 28:398–401PubMedCrossRefGoogle Scholar
  28. 28.
    Warren WD, Salam AA, Hutson D, Zeppa R (1974) Selective distal splenorenal shunt. Technique and results of operation. Arch Surg 108(3):306–314PubMedCrossRefGoogle Scholar
  29. 29.
    Collins JC, Rypins EB, Sarfeh IJ (1994) Narrow-diameter portacaval shunts for management of variceal bleeding. World J Surg 18(2):211–215PubMedCrossRefGoogle Scholar
  30. 30.
    Inokuchi K, Beppu K, Koyanagi N, Nagamine K, Hashizume M, Iwanaga T, Sugimachi K (1984) Fifteen years’ experience with left gastric venous caval shunt for esophageal varices. World J Surg 8(5):716–721PubMedCrossRefGoogle Scholar
  31. 31.
    Hillert C, Fischer L, Broering DC, Rogiers X (2003) Liver transplantation in patients with liver cirrhosis and esophageal bleeding. Langenbecks Arch Surg 388(3):150–154PubMedCrossRefGoogle Scholar
  32. 32.
    Imperiale TF, Chalasani N (2001) A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding. Hepatology 33:802–807PubMedCrossRefGoogle Scholar
  33. 33.
    The Veterans Affairs Cooperative Variceal Sclerotherapy Group (1991) Prophylactic sclerotherapy for esophageal varices in men with alcoholic liver disease. A randomized, single-blind, multicenter clinical trial. N Engl J Med 324:1779–1784CrossRefGoogle Scholar
  34. 34.
    Burroughs AK, D’Heygere F, McIntyre N (1986) Pitfalls in studies of prophylactic therapy for variceal bleeding in cirrhotics. Hepatology 6:1407–1413PubMedCrossRefGoogle Scholar
  35. 35.
    Jackson FC, Perrin AB, Smith AG, Dagradi AE, Nadal HM (1968) A clinical investigation of the portocaval shunt. II—Survival analysis of the prophylactic operation. Am J Surg 115:22–42PubMedCrossRefGoogle Scholar
  36. 36.
    Resnick RH, Chalmers TC, Ishihara AM, Garceau AJ, Callow AD, Schimmel EM et al (1969) A controlled study of the prophylactic porto-caval shunt—A final report. Ann Intern Med 70:675–688PubMedGoogle Scholar
  37. 37.
    Inokuchi K (1990) Improved survival after prophylactic portal non decompression surgery for esophageal varices: a randomized clinical trial. Cooperative Study Group of Portal Hypertension of Japan. Hepatology 12(1):1–6PubMedCrossRefGoogle Scholar
  38. 38.
    Pal S, Radhakrishna P, Sahni P, Pande GK, Nundy S, Chattopadhyay TK (2004) Prophylactic operations in portal hypertension due to extrahepatic portal venous obstruction in India: lessons learnt over two decades of experience. (APASL\Abstract\100). J Gastroenterol Hepatol 19(Suppl):A733Google Scholar
  39. 39.
    Pal S, Radhakrishna P, Sahni P, Pande GK, Nundy S, Chattopadhyay TK (2005) Prophylactic surgery in non-cirrhotic portal fibrosis: is it worthwhile? Indian J Gastroenterol 24(6):239–242PubMedGoogle Scholar
  40. 40.
    Sarin SK, Wadhawan M, Agarwal SR, Tyagi P, Sharma BC (2005) Endoscopic variceal ligation plus propranolol versus endoscopic variceal ligation alone in primary prophylaxis of variceal bleeding. Am J Gastroenterol 100:797–804PubMedCrossRefGoogle Scholar
  41. 41.
    Henderson JM, Yang Y (2005) Is there still a role for surgery in bleeding portal hypertension? Nat Clin Pract Gastroenterol Hepatol 2:246–247PubMedCrossRefGoogle Scholar
  42. 42.
    Rikkers LF, Jin G, Langnas AN, Shaw BW Jr (1997) Shunt surgery during the era of liver transplantation. Ann Surg 226:51–57PubMedCrossRefGoogle Scholar
  43. 43.
    Pal S, Desai PR, Rao YG, et al (2002) Non-cirrhotic portal fibrosis: results of surgery in 317 consecutive cases over a 25-year period from an Indian center (abstract). J Hepatobil Pancreat Surg 9(Supp1):F-278, p135 also in Gastroenterology 2002;122(Supplement 4), July/AugustGoogle Scholar
  44. 44.
    García-Pagán JC, Caca K, Bureau C, Laleman W, Appenrodt B, Luca A, Abraldes JG, Nevens F, Vinel JP, Mössner J, Bosch J, Early TIPS (Transjugular Intrahepatic Portosystemic Shunt) Cooperative Study Group (2010) Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 362(25):2370–2379PubMedCrossRefGoogle Scholar
  45. 45.
    Sarin SK, Govil A, Jain AK, Guptan RC, Issar SK, Jain M et al (1997) Prospective randomized trial of endoscopic sclerotherapy versus variceal band ligation for esophageal varices: influence on gastropathy, gastric varices and variceal recurrence. J Hepatol 26:826–832PubMedCrossRefGoogle Scholar
  46. 46.
    Sarin SK, Gupta N, Jha SK, Agrawal A, Mishra SR, Sharma BC, Kumar A (2010) Equal efficacy of endoscopic variceal ligation and propranolol in preventing variceal bleeding in patients with noncirrhotic portal hypertension. Gastroenterology 139(4):1238–1245PubMedCrossRefGoogle Scholar
  47. 47.
    Thomas V, Jose T, Kumar S (2009) Natural history of bleeding after esophageal variceal eradication in patients with extra hepatic portal venous obstruction: a 20 year follow-up. Indian J Gastroenterol 28:206–211PubMedCrossRefGoogle Scholar
  48. 48.
    Bhargava DK, Dasarathy S, Atmakuri SP, Dwivedi M (1990) Comparative efficacy of emergency endoscopic sclerotherapy for active variceal bleeding due to cirrhosis of the liver, non-cirrhotic portal fibrosis and extrahepatic portal venous obstruction. J Gastroenterol Hepatol 5:432–437PubMedCrossRefGoogle Scholar
  49. 49.
    Orloff MJ, Orloff MS, Girard B, Orloff SL (2002) Bleeding esophagogastric varices from extrahepatic portal hypertension: 40 years’ experience with portal-systemic shunt. J Am Coll Surg 194:717–728PubMedCrossRefGoogle Scholar
  50. 50.
    Bismuth H, Franco D, Alagille D (1980) Portal diversion for portal hypertension in children: the first ninety patients. Ann Surg 192:18–24PubMedCrossRefGoogle Scholar
  51. 51.
    Alvarez F, Bernard O, Brunelle F, Hadchouel P, Odièvre M, Alagille D (1983) Portal obstruction in children. II. Results of surgical portosystemic shunts. J Pediatr 103:703–707PubMedCrossRefGoogle Scholar
  52. 52.
    Mohapatra MK, Mohapatra AK, Acharya SK, Sahni P, Nundy S (1992) Encephalopathy in patients with extrahepatic obstruction after lienorenal shunts. Br J Surg 79(10):1103–1105PubMedCrossRefGoogle Scholar
  53. 53.
    Menon P, Rao KL, Bhattacharya A, Thapa BR, Chowdhary SK, Mahajan JK et al (2005) Extrahepatic portal hypertension: quality of life and somatic growth after surgery. Eur J Pediatr Surg 15:82–87PubMedCrossRefGoogle Scholar
  54. 54.
    Desai P (2000) Role of MRCP in delineating biliary abnormalities in patients with EHO before and after proximal lienorenal shunt [MCh (GI Surgery) dissertation]. All India Institute of Medical Sciences, New DelhiGoogle Scholar
  55. 55.
    Dhiman RK, Behera A, Chawla YK, Dilawari JB, Suri S (2007) Portal hypertensive biliopathy. Gut 56:1001–1008PubMedCrossRefGoogle Scholar
  56. 56.
    Singh RK, Pal S, Sahni P, Acharya SK, Chattopadhyay TK (2004) Obstructive jaundice due to portal biliopathy—our experience with shunt surgery. (APASL\Abstract\42). J Gastroenterol Hepatol 19(Suppl):A691Google Scholar
  57. 57.
    Chaudhary A, Dhar P, Sarin SK, Sachdev A, Agarwal AK, Vij JC et al (1998) Bile duct obstruction due to portal biliopathy in extrahepatic portal hypertension: surgical management. Br J Surg 85:326–329PubMedCrossRefGoogle Scholar
  58. 58.
    Pal S, Sahni P (2009) Extrahepatic portal venous obstruction: is the knife irrelevant? Indian J Gastroenterol 28(6):198–200PubMedCrossRefGoogle Scholar
  59. 59.
    Superina R, Bambini DA, Lokar J, Rigsby C, Whitington PF (2006) Correction of extrahepatic portal vein thrombosis by the mesenteric to left portal vein bypass. Ann Surg 243:515–521PubMedCrossRefGoogle Scholar
  60. 60.
    Sharma BC, Singh RP, Chawla YK, Narasimhan KL, Rao KL, Mitra SK (1997) Effect of shunt surgery on spleen size, portal pressure and esophageal varices in non cirrhotic portal fibrosis. J Gastroenterol Hepatol 12:582–584PubMedCrossRefGoogle Scholar
  61. 61.
    Orozco H, Takahashi T, Mercado MA, Garcia-Tsao G, Hernandez-Ortiz J (1991) The Sugiura procedure for patients with haemorrhagic portal hypertension secondary to extrahepatic portal vein thrombosis. Surg Gynecol Obstet 173:45–48PubMedGoogle Scholar
  62. 62.
    Goyal N, Singhal D, Gupta S, Soin AS, Nundy S (2007) Transabdominal gastroesophageal devascularization without transection for bleeding varices: results and indicators of prognosis. J Gastroenterol Hepatol 22:47–50PubMedCrossRefGoogle Scholar
  63. 63.
    Khan S, Tudor Smith C, Williamson P, Sutton R (2006) Portosystemic shunts versus endoscopic therapy for variceal rebleeding in patients with cirrhosis. Cochrane Database Syst Rev (4):CD000553Google Scholar
  64. 64.
    Johnson M, Rajendran S, Balachandar TG, Kannan D, Jeswanth S, Ravichandran P, Surendran R (2006) Transabdominal modified devascularization procedure with or without esophageal stapler transection–an operation adequate for effective control of a variceal bleed. Is esophageal stapler transection necessary? World J Surg 30(8):1507–1518PubMedCrossRefGoogle Scholar
  65. 65.
    Ezzat FA, Abu-Elmagd KM, Aly MA, Fathy OM, El-Ghawlby NA, El-Fiky AM, El-Barbary MH (1990) Selective shunt versus nonshunt surgery for management of both schistosomal and nonschistosomal variceal bleeders. Ann Surg 212(1):97–108PubMedCrossRefGoogle Scholar
  66. 66.
    Abu-Elmagd KM, Aly MA, Fathy OM, E-Ghawlby NA, El-Fiky AM, El-Barbary MH, El-Hak NG, El-Ebady GE, Sultan A, Bahgat OO et al (1993) Ten years of experience with patients with chronic active liver disease variceal bleeding: ablative versus selective decompressive therapy. Surgery 114(5):868–881PubMedGoogle Scholar
  67. 67.
    Singhal D, Goyal N, Soin AS, Gupta S, Nundy S (2007) What are the essential components of a transabdominal devascularization procedure for bleeding esophageal varices? World J Surg 31(4):861–862, LetterPubMedCrossRefGoogle Scholar
  68. 68.
    Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK (1992) Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 16:134–139CrossRefGoogle Scholar
  69. 69.
    Mishra SR, Sharma BC, Kumar A, Sarin SK (2011) Primary prophylaxis of gastric variceal bleeding comparing cyanoacrylate injection and beta-blockers: a randomized controlled trial. J Hepatol 54(6):1161–1167PubMedCrossRefGoogle Scholar
  70. 70.
    Mishra SR, Sharma BC, Kumar A, Sarin SK (2010) Endoscopic cyanoacrylate injection versus beta-blocker for secondary prophylaxis of gastric variceal bleed: a randomised controlled trial. Gut 59(6):729–735PubMedCrossRefGoogle Scholar
  71. 71.
    Ryan BM, Stockbrugger RW, Ryan JM (2004) A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices. Gastroenterology 126(4):1175–1189PubMedCrossRefGoogle Scholar
  72. 72.
    Lo GH, Liang HL, Chen WC, Chen MH, Lai KH, Hsu PI et al (2007) A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt vs. cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy 39:679–685PubMedCrossRefGoogle Scholar
  73. 73.
    Hong CH, Kim HJ, Park JH (2009) Treatment of patients with gastric variceal hemorrhage: endoscopic N-butyl-2-cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol 24:372–378PubMedCrossRefGoogle Scholar
  74. 74.
    Thomas PG, D’Cruz AJ (1994) Distal splenorenal shunting for bleeding gastric varices. Br J Surg 81:241–244PubMedCrossRefGoogle Scholar
  75. 75.
    Rosemurgy AS, Serafini FM, Zweibel BR, Black TJ, Kudryk BT, Nord HJ, Goode SE (2000) Transjugular intrahepatic portosystemic shunt vs. small-diameter prosthetic H-graft portacaval shunt: extended follow-up of an expanded randomized prospective trial. J Gastrointest Surg 4(6):589–597PubMedCrossRefGoogle Scholar
  76. 76.
    Rosemurgy AS, Zervos EE, Bloomston M, Durkin AJ, Clark WC, Goff S (2003) Post-shunt resource consumption favors small-diameter prosthetic H-graft portacaval shunt over TIPS for patients with poor hepatic reserve. Ann Surg 237(6):820–825, discussion 825–827PubMedGoogle Scholar
  77. 77.
    Rosemurgy AS, Bloomston M, Clark WC, Thometz DP, Zervos EE (2005) H-graft portacaval shunts versus TIPS: ten-year follow-up of a randomized trial with comparison to predicted survivals. Ann Surg 241(2):238–246PubMedCrossRefGoogle Scholar
  78. 78.
    Henderson JM, Boyer TD, Kutner MH, Galloway JR, Rikkers LF, Jeffers LJ, Abu-Elmagd K, Connor J, DIVERT Study Group (2006) Distal splenorenal shunt versus transjugular intrahepatic portal systemic shunt for variceal bleeding: a randomized trial. Gastroenterology 130(6):1643–1651PubMedCrossRefGoogle Scholar
  79. 79.
    Kohli V, Pande GK, Dev V, Reddy KS, Kaul U, Nundy S (1993) Management of hepatic venous outflow obstruction. Lancet 342:718–722PubMedCrossRefGoogle Scholar
  80. 80.
    Zeitoun G, Escolano S, Hadengue A, Azar N, El Younsi M, Mallet A et al (1999) Outcome of Budd-Chiari syndrome: a multivariate analysis of factors related to survival including surgical portosystemic shunting. Hepatology 30:84–89PubMedCrossRefGoogle Scholar
  81. 81.
    Srinivasan P, Rela M, Prachalias A, Muiesan P, Portmann B, Mufti GJ, Pagliuca A, O’Grady J, Heaton N (2002) Liver transplantation for Budd-Chiari syndrome. Transplantation 73:973–977PubMedCrossRefGoogle Scholar
  82. 82.
    Mentha G, Giostra E, Majno PE, Bechstein WO, Neuhaus P, O’Grady J et al (2006) Liver transplantation for Budd-Chiari syndrome: a European study on 248 patients from 51 centres. J Hepatol 44:520–528PubMedCrossRefGoogle Scholar
  83. 83.
    Singhal D, de Castro S, Goyal N, Gouma DJ, Chaudhary A, van Gulik TM (2006) Current role of PSS in the management of HVOO. Dig Surg 23:358–369PubMedCrossRefGoogle Scholar
  84. 84.
    Kaul U, Agarwal R, Jain P, Sharma S, Sharma S, Wasir HS (1996) Management of idiopathic obstruction of the hepatic and suprahepatic inferior vena cava with a self-expanding metallic stent. Cathet Cardiovasc Diagn 39:252–257PubMedCrossRefGoogle Scholar
  85. 85.
    Rossle M, Olschewski M, Siegerstetter V, Berger E, Kurz K, Grandt D (2004) The Budd-Chiari syndrome: outcome after treatment with the transjugular intrahepatic portosystemic shunt. Surgery 135:394–403PubMedCrossRefGoogle Scholar

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© Association of Surgeons of India 2011

Authors and Affiliations

  1. 1.Department of GI surgery and Liver TransplantationAll India Institute of Medical SciencesNew DelhiIndia

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